Administration of intravenous morphine for acute pain in the emergency department inflicts an economic burden in Europe

Article Details

Authors
Montserrat Casamayor MD, PhD, Karen DiDonato MSN, RN, Marc Hennebert MBA, MS, Luca Brazzi MD, PhD, Gregor Prosen MD, FEBEM

Article Type
Original Research

DOI
10.7573/dic.212524

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Abstract

Background: Acute pain is among the leading causes of referral to the emergency department (ED) in industrialized countries. Its management mainly depends on intensity. Moderateto- severe pain is treated with intravenous (IV) administered opioids, of which morphine is the most commonly used in the ED. We have estimated the burden of IV administration of morphine in the five key European countries (EU5) using a micro-costing approach.

Scope: A structured literature review was conducted to identify clinical guidelines for acute pain management in EU5 and clinical studies conducted in the ED setting. The data identified in this literature review constituted the source for all model input parameters, which were clustered as analgesic (morphine), material used for IV morphine administration, nurse workforce time and management of morphine-related adverse events and IV-related complications.

Findings: The cost per patient of IV morphine administration in the ED ranges between €18.31 in Spain and €28.38 in Germany. If costs associated with the management of morphine-related adverse events and IV-related complications are also considered, the total costs amount to €121.13–€132.43. The main driver of those total costs is the management of IV-related complications (phlebitis, extravasation and IV prescription errors; 73% of all costs) followed by workforce time (14%).

Conclusions: IV morphine provides effective pain relief in the ED, but the costs associated with the IV administration inflict an economic burden on the respective national health services in EU5. An equally rapid-onset and efficacious analgesic that does not require IV administration could reduce this burden.

Keywords: acute pain, analgesia, cost analysis, emergency departments, Europe, morphine, nurse, opioids, pain management.

Citation: Casamayor M, DiDonato K, Hennebert M, Brazzi L, Prosen G. Administration of intravenous morphine for acute pain in the emergency department inflicts an economic burden in Europe. Drugs in Context 2018; 7: 212524. DOI: 10.7573/dic.212524

Contributions: KD conceived and designed the study, MC and MH conducted the structured literature review and micro-costing analysis. MC drew the outline of the manuscript, and KD, LB, GP, MC and MH drafted the manuscript. All authors analyzed and interpreted the data, critically revised successive drafts of the manuscript and have approved the final version.

Disclosure and potential conflicts of interest: The research described in this article, the drafting of this manuscript and its publication were funded by AcelRx. KD is an employee of AcelRx. The work of IQVIA was funded by AcelRx. MC and MH are consultants to AcelRx. LB and GP are physicians. LB reports honorarium from BBraun Italia, Medtronic and MSD, and GP from AcelRx. The International Committee of Medical Journal Editors (ICMJE) Potential Conflicts of Interests form for the authors are available for download at: http://www.drugsincontext.com/wp-content/uploads/2018/03/dic.212524-COI.pdf

Acknowledgements: The abstract of this paper was presented at the ISPOR 19th Annual European Congress in Vienna, as a poster presentation with interim findings. The poster’s abstract was published in ‘Poster Abstracts’ in Value Health 2016;19(7):A582; available at http://www.valueinhealthjournal.com/article/S1098-3015(16)32726-7/abstract. Editing assistance was provided by BlueMomentum, an Ashfield Company, part of UDG Healthcare plc and was funded by AcelRx.

Funding declaration: This research was funded exclusively by AcelRx.

Copyright: Copyright © 2018 Casamayor M, DiDonato K, Hennebert M, Brazzi L, Prosen G. Published by Drugs in Context under Creative Commons License Deed CC BY NC ND 4.0 which allows anyone to copy, distribute, and transmit the article provided it is properly attributed in the manner specified below. No commercial use without permission.

Correct attribution: Copyright © 2018 Casamayor M, DiDonato K, Hennebert M, Brazzi L, Prosen G. https://doi.org/10.7573/dic.212524. Published by Drugs in Context under Creative Commons License Deed CC BY NC ND 4.0.

Article URL: http://www.drugsincontext.com/administration-of-intravenous-morphine-for-acute-pain-in-the-emergency-department-inflicts-an-economic-burden-in-europe

Correspondence: Karen DiDonato, AcelRx, 351 Galveston Drive, Redwood City, CA 94063, USA. kdidonato@acelrx.com

Provenance: submitted; externally peer reviewed.

Submitted: 13 December 2017; Peer review comments to author: 12 February 2018; Revised manuscript received: 13 March 2018; Accepted: 15 March 2018; Publication date: 11 April 2018.

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