NDLI: Cost benefit analysis of amethocaine (Ametop) compared with EMLA for intravenous cannulation in a children's emergency department.

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Cost benefit analysis of amethocaine (Ametop) compared with EMLA for intravenous cannulation in a children's emergency department.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Herd, David W. Newbury, Clinton Brown, Paul M.
Description	Country affiliation: New Zealand Author Affiliation: Herd DW ( Children's Emergency Department, Starship Children's Hospital, Park Road, Auckland 1023, New Zealand. david.herd@mac.com)
Abstract	INTRODUCTION: Starship Hospital Children's Emergency Department (CED) uses EMLA for topical anaesthesia during insertion of intravenous cannula (IVC). Amethocaine has recently been shown to offer more effective pain relief and work faster than EMLA, but may be more expensive. AIM: To determine cost implications of introducing topical amethocaine into CED practice. METHODS: Data were obtained from a randomised controlled trial, quality assurance project and an audit of topical anaesthetic use, with economic evaluation performed from the District Health Board perspective in 2007 NZ dollars and Euros. Proportion of children receiving topical anaesthetic cream during insertion of IVC was the primary benefit measure, and cost per child presenting to the department was the primary cost measure. A decision tree model was developed as a baseline, and sensitivity analysis was conducted. Multiple clinical scenarios were modelled, and incremental cost effectiveness ratios calculated compared to the baseline model. RESULTS: Scenarios modelled include providing no topical anaesthesia, using amethocaine exclusively or using a mixture of amethocaine and EMLA. All models are sensitive to the amount of cream applied at triage. The most cost effective model provided EMLA at triage to those most likely to need IVC; then amethocaine to other children later thought to require IVC. This model would cost NZ\$1.05 per child, down from NZ\$1.47. Proportion of children receiving cream during insertion of IVC would increase from 51% to 64%. The recommended model dominated the current situation. CONCLUSION: Use of amethocaine in a mixed model in the CED could reduce cost and increase the proportion of children receiving topical anaesthetic during insertion of IVC. Trial registration number Australian New Zealand Clinical Trials Register ACTRN12606000409572.
File Format	HTM / HTML
ISSN	14720205
Issue Number	6
Volume Number	27
e-ISSN	14720213
Journal	Emergency Medicine Journal
Language	English
Publisher	BMJ Publishing Group Ltd
Publisher Date	2010-06-01
Publisher Place	Great Britain (UK)
Access Restriction	One Nation One Subscription (ONOS)
Subject Keyword	Discipline Emergency Discipline Medicine Anesthetics, Local Economics Child Health Services Emergency Service, Hospital Tetracaine Administration, Topical Child Cost-benefit Analysis Decision Trees Humans Infusions, Intravenous Medical Audit Journal Article Research Support, Non-u.s. Gov't
Content Type	Text
Resource Type	Article
Subject	Emergency Medicine Critical Care and Intensive Care Medicine

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