Administration of intravenous morphine for acute pain in the emergency department inflicts an economic burden in Europe.
Administration of intravenous morphine for acute pain in the emergency department inflicts an economic burden in Europe.
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DOI：
10.7573/dic.212524
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发表时间：
2018
期刊：
影响因子：
--
通讯作者：
Prosen G
中科院分区：
文献类型：
--
作者：
Casamayor M;DiDonato K;Hennebert M;Brazzi L;Prosen G
在工业化国家，急性疼痛是转诊到急诊科（ED）的主要原因。其管理主要依靠强度。中度至重度疼痛通过静脉（IV）给药阿片类药物治疗，其中吗啡是ED中最常用的。我们使用微观成本法估计了五个主要欧洲国家（EU5）静脉给药吗啡的负担。我们进行了一项结构化的文献综述，以确定EU5急性疼痛管理的临床指南和在急诊科进行的临床研究。本文献综述中确定的数据构成了所有模型输入参数的来源，这些参数被聚类为镇痛药（吗啡）、静脉注射吗啡所用的材料、护士工作时间以及吗啡相关不良事件和静脉注射相关并发症的管理。在急诊科，每位患者静脉注射吗啡的费用在西班牙的18.31欧元和德国的28.38欧元之间。如果还考虑与吗啡相关不良事件和静脉注射相关并发症管理相关的成本，则总成本为121.13欧元至132.43欧元。这些总成本的主要驱动因素是静脉注射相关并发症的管理（静脉炎、外渗和静脉注射处方错误；占所有成本的73%），其次是工作时间（14%）。静脉注射吗啡可以有效缓解急诊科的疼痛，但与静脉注射相关的费用给欧盟5国各自的国家卫生服务造成了经济负担。一种同样快速起效且不需要静脉给药的镇痛药可以减轻这种负担。
Acute pain is among the leading causes of referral to the emergency department (ED) in industrialized countries. Its management mainly depends on intensity. Moderate-to-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. 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. 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%). 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.