Cost effectiveness analysis of intravenous ketorolac and morphine for treating pain after limb injury: double blind randomised controlled trial

Rainer, Timothy H associate professor
Jacobs, Philip professor
Ng, Y C associate professor
Cheung, N K associate professor
Tam, Michael associate professor
Lam, Peggo K W statistician
Wong, Robert business manager
Cocks, Robert A professor and director

¹Accident and Emergency Medicine Academic Unit, Chinese University of Hong Kong, Rooms G05/06, Cancer Center, Prince of Wales Hospital, Shatin, NT, Hong Kong, ²Department of Public Health Sciences, Faculty of Medicine and Oral Health Sciences, University of Alberta, 13-103 Clinical Sciences Building, Edmonton, Alberta, Canada T6G 2G3, ³Department of Economics, Hong Kong Baptist University, 224 Waterloo Road, Kowloon Tong, Kowloon, Hong Kong, ⁴Centre for Clinical Trials and Epidemiological Research, Flat 7B, 7th floor, Block B, Staff Quarters, Prince of Wales Hospital, Shatin, ⁵Finance Department, Prince of Wales Hospital, Shatin

Accepted for publication 8 August 2000

Contributors Contributors: THR had the idea for the study, obtained approval, and has overseen the entire planning, execution, and analysis of the study, and the preparation of the manuscript. He is guarantor of the paper. PJ and YCN participated in planning a detailed economic analysis. NKC, MT, and RAC participated in the planning, execution, and analysis. PKWL and THR prepared the statistical analysis. RW was involved in planning and costing analysis. THR wrote the first draft of the paper, and all authors have contributed to the final version.

Correspondence to: T H Rainer [email protected]

Funding: This study was supported by the direct grants scheme of the Chinese University of Hong Kong (project code 2040668) and the Health Services Research Committee of Hong Kong (project code 921020).

Competing interests: None declared.

BMJ 321(7271):p 1247-1251, November 18, 2000.

Objectives

To investigate the cost effectiveness of intravenous ketorolac compared with intravenous morphine in relieving pain after blunt limb injury in an accident and emergency department.

Design

Double blind, randomised, controlled study and cost consequences analysis.

Setting

Emergency department of a university hospital in the New Territories of Hong Kong.

Participants

148 adult patients with painful isolated limb injuries (limb injuries without other injuries).

Main outcome measures

Primary outcome measure was a cost consequences analysis comparing the use of ketorolac with morphine; secondary outcome measures were pain relief at rest and with limb movement, adverse events, patients' satisfaction, and time spent in the emergency department.

Results

No difference was found in the median time taken to achieve pain relief at rest between the group receiving ketorolac and the group receiving morphine, but with movement the median reduction in pain score in the ketorolac group was 1.09 per hour (95% confidence interval 1.05 to 2.02) compared with 0.87 (0.84 to 1.06) in the morphine group (P=0.003). The odds of experiencing adverse events was 144.2 (41.5 to 501.6) times more likely with morphine than with ketorolac. The median time from the initial delivery of analgesia to the participant leaving the department was 20 (4.0 to 39.0) minutes shorter in the ketorolac group than in the morphine group (P=0.02). The mean cost per person was $HK44 (£4; $5.6) in the ketorolac group and $HK229 in the morphine group (P<0.0001). The median score for patients' satisfaction was 6.0 for ketorolac and 5.0 for morphine (P<0.0001).

Conclusion

Intravenous ketorolac is a more cost effective analgesic than intravenous morphine in the management of isolated limb injury in an emergency department in Hong Kong, and its use may be considered as the dominant strategy.