ABSTRACT
Objetivo: Determinar el costo unitario y el costo operacional, para identificar los elementos y más importantes variables. Material y método: Diseño: retrospectivo, descriptivo y transversal. Los pacientes fueron 53 mujeres en trabajo de parto. Ellas reciberon analgesia epidural en enero de 2006 en el Instituto Nacional Materno Perinatal INMP. El instrumento utilizado fue una encuesta para analizar los costos. Los tipos de costos fueron calculados por la metodología del sistema de "información de la gestión hospitalaria", determinando el porcentaje que ocupa cada variable, el gasto conocido de cada unidad, el costo unitario y total de la producción obtenida. Resultados: Los honorarios profesionales es una variable que tiene el mayor peso y representa el 74% del costo en todo el servicio, los insumos terapéuticos y el costo de ropa representan el 14%, por último, la depreciación de los equipos médicos, mobiliario y la infraestructura representan el 12%. Conclusión: La analgesia epidural durante el parto aumenta los costos de servicios en S /. 379,00, que es un precio asequible para las mujeres en trabajo de parto.
Objective: To determine unitary costs and operational costs, and to identify the elements and the most important variables when using epidural analgesia for labor. Material and method: Design: retrospective, descriptive, and cross-sectional study. Patients included were 53 women in labor. They received epidural analgesia for delivery in January 2006 at the Instituto Nacional Materno Perinatal (the main Maternity Hospital in Lima, Peru). The instrument used was a survey for estimating costs. Costs types are calculated using a methodology assessing information of hospital management, determining the percentage attributable for every variable, knowing expenses for every unit we calculated unitary expenses and total production costs. Results: Professional fees is a variable with the maximum weight, and it represents 74% of costs within the whole service, therapeutic material and costs of clothing represent 14%, and depreciation of medical equipments, furniture, and infrastructure represent 12%. Conclusion: Epidural analgesia during labor increases service costs in S/. 379.00, which is an affordable price for women in labor.
Subject(s)
Humans , Female , Analgesia, Epidural/economics , Parturition , Epidemiology, Descriptive , Retrospective Studies , Cross-Sectional StudiesABSTRACT
OBJECTIVES: To compare the effectiveness and cost of thoracic patient-controlled epidural analgesia (TPCEA) using bupivacaine with fentanyl (BF) vs bupivacaine with morphine (BM) solution. MATERIAL AND METHOD: In a blinded, randomized controlled trial, 90 adult patients who were scheduled for thoracotomy or upper abdominal surgery were enrolled. All patients were anesthetized by a combined general/epidural technique. Intraoperative and postoperative analgesia was provided by TPCEA using bupivacaine 0.0625% with either fentanyl (group BF) or morphine (group BM) solution. The occurrence and severity of side effects, visual analogue scale (VAS) for pain at rest and during movement, patients' satisfaction score as well as charged cost of pain and side effect management were recorded for 48 hrs. RESULTS: Demographic data of both groups were not significantly different. No statistical differences were noted with respect to efficacy of pain relief between the 2 groups. Only 28.5% of the patients in group BM required supplemental systemic analgesia within 24 hours after epidural catheter removal compared with 51.4% in the group BE Patients' satisfaction and the severity of epidural analgesia related side effects, using itching and nausea/vomiting score, of both groups were not significantly different except the median nausea/ vomiting scores of group BM at 18 and 24 hours were statistically higher than those of group BF (P = 0.047 and 0.02, at 18 and 24 hour respectively) but not clinically different. The mean charged cost of medication used in group BM (470.64 +/- 160.54 baht) was lower than that in group BF (814.15 +/- 217.51 baht). CONCLUSION: TPCEA using BF and BM solution resulted in similar pain relief and side effect profiles but with higher charged cost of medication in group BF Morphine appears to be a more cost-effective choice than fentanyl for TPCEA after thoracotomy or upper abdominal surgery.