1. Duramorph –A Cost Analysis Scott Frankfather, M.D. PGY IV Robert Casanova, M.D. Texas Tech Physicians Department of Obstetrics and Gynecology March 6, 2009

2. Duramorph—A Cost Analysis Objective: To evaluate the cost effectiveness of intrathecal morphine during spinal anesthesia for cesarean section.

3. Duramorph—A Cost Analysis Background: Cesarean section is the most commonly performed surgery in the United States. 26% of all deliveries in 2002. –Anesthesia includes »Epidural »Spinal »General »Local

4. Duramorph—A Cost Analysis Background: –The most common types of anesthesia: »epidural or spinal anesthesia. –The addition of morphine to the intrathecal (spinal) anesthesia is becoming a more common practice »pain relief for up to twenty-four hours »Negates need for patient controlled analgesia (PCA) –Patients require additional medications »Oral narcotics »Intravenous or intramuscular narcotics »Antihistamines »Antiemetics

5. Duramorph—A Cost Analysis Background: –A review of literature in PubMed found no study evaluating the cost-effectiveness of intrathecal morphine.

6. Duramorph—A Cost Analysis Study Design: –Retrospective chart review comparing medication costs of patients receiving intrathecal morphine anesthesia and matched controls of patients receiving spinal anesthesia with PCA between January 1, 2008 and December 31, 2008 at University Medical Center.

7. Duramorph—A Cost Analysis –Hypothesis: Intrathecal morphine provides adequate pain relief but is not cost effective when considering all additional medications required by the patient.

8. Duramorph—A Cost Analysis Materials and Methods: –The patients were identified using the Premier software with the assistance of the office of Performance Improvement at University Medical Center in Lubbock, Texas. –The costs of all anesthesia related medications following a cesarean section were analyzed.

9. Duramorph—A Cost Analysis Materials and Methods: –After identifying patients of interest and obtaining the total cost of medications of interest, all patient identifiers were removed from the data. –Data collected included: Gravidity Parity Weight Type of anesthesia Skin incision Cost of all pain medication Cost of medication resulting from administration of anesthesia.

10. Duramorph—A Cost Analysis Materials and Methods: –Population: 617 patients who underwent a cesarean section between January 1, 2008 and December 31, 2008. –Subdivided into groups according to type of anesthesia Duramorph Group: 54 Patients PCA Group: 104 Patients were selected randomly from 517 who received spinal with PCA

11. Duramorph—A Cost Analysis Materials and Methods: –Exclusion criteria: Hospital stays longer than 7 days –n=3 from Duramorph group –n=32 from PCA group Incomplete medical records (n=2) Duplicated anesthesia charges (n=18) No anesthesia charges (n=28)

12. Results Type of Anesthesia Number Of Patients Individual Cost Additional Costs Total Cost Duramorph54$3.93$14.43$18.14 PCA517$18.76$15.50$33.76 Total C-sections 617

13. Results DuramorphPCA Age28.7624.69 Weight91.0090.48 Gravidity2.742.27 Parity1.320.93 Cesarean #1.911.58

14. Results DuramorphPCA Total Cost$16.92$24.20 Individual Cost$3.76$18.10 Other Costs$13.38$16.10 Total Charges$3552.11$3888.43 Length of Stay3.16 days3.55 days Average costs of medications excluding the cost of PCA pump

15. Conclusion Intrathecal morphine provides adequate pain relief and is cost effective when considering all additional medications required by the patient. A direct comparison of the mean medication cost reveals a statistically significant yet small savings; however, the amount saved by using Duramorph spinal is $336.32 per patient when considering all charges to the patient.

16. References Cunningham, Leveno, et al. Willimas Obstetrics. 22nd ed. New York: McGraw-Hill, 2005. 473-490, 588-590. Gabbe, Niebyl, et al.,eds. Obstetrics: Normal and Problem Pregnancies. 4th ed. Philadelphia: Churchill Livingston, 2002. 539-543, 458-465

17. Thank You Dr. Casanova Dr. Prien Karen Lemons Shane Terrell Todd Jackson, RPh.