The cost-effectiveness of thoracic epidural versus paravertebral blockade in reducing chronic post-thoracotomy pain - a trial-based economic evaluation

Thoracotomy surgery is associated with high levels of acute pain and can lead to chronic post-surgical pain. Two methods of regional analgesia are commonly used in patients undergoing thoracotomy surgery, thoracic epidural blockade (TEB) and paravertebral blockade (PVB). The economic evaluation aimed to compare PVB to TEB, in terms of both costs and outcomes, and assess the cost-effectiveness of the different analgesic techniques, considering both impacts on chronic pain and health-related quality of life. TOPIC-2 was a prospective, multi-centre, randomised, open-label, parallel-group, superiority trial of 770 adult ([≥]18 years old) thoracotomy patients, recruited from secondary care. The main economic analysis aimed to assess cost-effectiveness based on incremental cost per quality-adjusted life year (QALY) gained at 12 months post-randomisation, with a secondary analysis of cost per case of chronic post-thoracotomy pain (CPTP) avoided at 6 months. The cost-utility analysis demonstrated that TEB resulted in slightly more QALYs at 12 months and was slightly more costly than PVB; however, the differences in costs and outcomes were not statistically significant at the 95% level. The results the sensitivity analyses showed that there was considerable uncertainty around the difference in costs and outcomes between the treatment groups. The results of the analysis support the findings of other studies which suggest that there is no difference in the incidence of CPTP between patients receiving PVB compared with TEB and provides additional insights on health-related quality of life and costs. The study provides important information around chronic post-operative pain for policy makers, clinicians and patients.