Cost-effectiveness analysis of anesthetic agents during peripheral intravenous cannulation in the pediatric emergency department

Objective: To conduct a cost-effectiveness analysis of anesthetic agents to reduce the pain of peripheral intravenous cannulation in an emergency department (ED) setting. Design: Cost-effectiveness analysis in which costs were measured as the cost of the agent plus costs associated with time in the ED using data from our hospital cost accounting system. Outcomes were measured as improvements in the self-reported visual analog scale (VAS) pain scores. Variables considered unique to the various agents were cost of the agent, time to peak onset, success rates of cannulation, and mean reduction in VAS scores. Setting: Decision model. Patients: A cohort of patients aged 3 through 18 years enrolled in randomized controlled trials that compared analgesic modalities to facilitate peripheral intravenous cannulation was identified through medical databases searched from their inception (earliest year, 1966) through June 2007. Main Outcome Measures: The main outcome measure was the incremental cost-effectiveness ratio, which represented the additional cost that must be incurred by the hospital to obtain a reduction of 1 additional unit (10 mm or 1 cm) in the VAS score compared with a baseline option of no anesthetic. Results: Our results suggest that the needle-free jet injection of lidocaine device had the lowest incremental cost-effectiveness ratio, followed by intradermal injection of buffered lidocaine; lidocaine iontophoresis; nitrous oxide inhalation analgesia; a heated lidocaine and tetracaine patch; sonophoresis with lidocaine cream, 4%; lidocaine cream alone, 4%; and use of a eutectic mixture of lidocaine and prilocaine cream. Conclusion: Currently, the needle-free jet injection of lidocaine device and injection of buffered lidocaine appear to provide the most cost-effective alternatives to pediatric ED physicians.