The Cost of Multimodal vs Opioid Postoperative Pain Regimens for the Foot & Ankle Surgical Patient

CATEGORY: Other; Other INTRODUCTION/ PURPOSE: Orthopedic surgeons are one of the highest prescribing specialties of opioids in medicine. To address the ongoing opioid crisis in the United States, many surgeons have adopted multimodal regimens for post-operative pain control to decrease the need for opioids. Recent studies have demonstrated the effectiveness of opioid-sparing multimodal pain management therapies when compared to opioid inclusive therapies. However, to date there are no published studies analyzing the cost of multimodal vs opioid postoperative pain regimens for the elective foot & ankle surgical post-surgical patient. METHODS: A secondary analysis of data collected from two studies that evaluated pain control after elective forefoot surgery was analyzed. The index study examined the number of opioid pills consumed post-operatively. A follow-up then examined the clinical utility of the non-opioid pain regimen for pain control post-operatively. Medications in the non-opioid multimodal regimen included cyclobenzaprine, ketorolac, meloxicam, pregabalin, and acetaminophen. Using information collected during these two studies, deidentified patient profiles were constructed using the patient’s insurance carrier and preferred pharmacy to determine the cost of each patient’s post-operative regimen (narcotics vs multimodal). All patients, 40 patients from the multimodal pain pathway study and 59 from the opioid pain control study, were included in this analysis and their prescription costs were totaled and analyzed. RESULTS: A box plot was constructed to visualize data and identify outliers to be removed for data analysis. Prescriptions in the opioid group had an average cost of $8.92 (SD=$5.74) while the multimodal group had an average cost of $25.60 (SD=$10.49), p CONCLUSION: Patients whose post-operative pain was managed by an opioid-free multimodal regimen had statistically significant higher prescription costs than with opioid monotherapy regardless of health insurance type. However, the difference may not be clinically significant as on average it was $17. As more studies demonstrate the effectiveness of opioid-free post-operative pain management, it may be reassuring to surgeons that despite a greater number of medications with the multimodal protocol the average cost difference was only about $17. This information may allow surgeons to prescribe this regimen to all patients regardless of socioeconomic status and continue to decrease post-operative opioid prescriptions.