Abstract
ObjectivesTo understand individual prescribing and associated costs in patients managed with the Edinburgh Pain Assessment and management Tool (EPAT). MethodsThe EPAT study was a two-arm parallel group cluster randomised (1:1) trial, including 19 UK cancer centres. Study outcome assessments, including pain levels, analgesia and non-pharmacological and anaesthetic interventions, collected at baseline, 3-5 days and, if applicable, 7-10 days after admission. Costs calculated for inpatient length of stay (LoS), medications and complex pain interventions. Analysis accounted for the clustered nature of the trial design. In this post-hoc analysis, healthcare utilisation and costs are presented descriptively. Participants10 centres randomised to EPAT (487 patients) and 9 (449 patients) to usual care (UC). Main outcome measuresPharmacological and non-pharmacological management, complex pain interventions, length of hospital stay and costs related to these outcomes. ResultsThe mean per patient hospital cost was 3866 pound with EPAT and 4194 pound with UC, reflecting a mean LoS of 2.9 days and 3.1 days, respectively. Costs were lower for non-opioids, Non-steroidal anti-inflammatories (NSAIDs) and opioids but slightly higher for adjuvants with EPAT than with UC. The mean per-patient opioid costs were 17.90 pound (EPAT) and 25.80 pound (UC). Mean per patient costs of all medication were 36 pound (EPAT) and 40 pound (UC).Complex pain intervention costs were 117 pound with EPAT per patient and 90 pound with UC. Overall mean cost per patient was 4018.3 pound (95% CI 3698.9 to 4337.8) with EPAT and 4323.8 pound (95% CI 4060.0 to 4587.7) with UC. ConclusionsEPAT facilitated personalised medicine and may result in less opioids, more specific treatments, improved pain outcomes and cost savings.