(168) Analgesia Versus No-Analgesia in the Management of Neonates Undergoing Mechanical Ventilation in the Intensive Care Setting in Qatar. A Cost-Effectiveness Analysis
Background: Morphine as an analgesic agent has been widely used in ventilated neonates with respiratory distress syndrome (RDS). However, overuse of morphine may have unfavorable outcomes.
Objectives: We aimed to perform a cost-effectiveness analysis among two currently used strategies; analgesia versus no analgesia in the main neonatal intensive care unit (NICU) in HMC, Qatar.
Methods: A retrospective cohort-based study to determine the clinical and economic outcomes of analgesia (i.e. morphine) versus no analgesia (i.e no morphine). A decision-analytic model was constructed, from the hospital perspective, to follow the clinical and economic consequences. The course regimen of morphine was a loading dose of 100-200 μg/kg, followed by a continuous infusion of 15-30 mcg/kg/hour. Clinical and resource utilization data were extracted from Cerner medical database, from 2016 through 2019, at the tertiary NICU in Qatar. The primary outcome measures were the rate of successful pain relief, based on the Premature Infant Pain Profile, and the overall direct medical cost management. A population of 1000 neonates was required for results with 80% power and 0.05 significance.
Results: A total of 406 were available for inclusion into the analgesia group versus 440 in the no analgesia group, where the successful pain relief was reported in 93% of cases with no analgesia, compared to a reduced success with analgesia (67%). The total costs were also lower with no analgesia versus analgesia (QAR23,073 (US$6,321versus QAR41,985 (US$11,502)), yielding a cost saving of QAR18,912 (US$5,181). Sensitivity analyses confirmed the robustness of study conclusions.
Conclusions: This is the first cost-effectiveness evaluation of analgesia versus no analgesia among ventilated neonates with RDS. No analgesia was shown to be a dominant choice of management with an enhanced pain relief, at a considerably lower cost. The study results support recent trends in NICU practices in favor of the no analgesia use.
