Cost Effectiveness of Combined Spinal-Epidural Analgesia Compared with Continuous Infusion Epidural Analgesia for Labor

Birnbach DJ, Bourlier RA, Stein DJ, Danzer BI, Ramasamy M, Thys DM Department of Anesthesiology. St. Luke's- Roosevelt Hospital Center, College of Physicians and Surgeons of Columbia University, NY

Introduction: Although combined spinal-epidural (CSE) analgesia for labor has recently become very popular, little information is available to compare the cost of this new technique against a standard epidural anesthetic. The aim of this study was to estimate the costs of each of three labor analgesia options commonly used at our institution.

Methods: A retrospective analysis of six months of labor analgesia in healthy parturients who progressed to normal spontaneous vaginal delivery was undertaken. The following costs were examined: cost of continuous infusion epidural, cost of CSE where the patient delivered before an epidural infusion was initiated, and the cost of CSE where an epidural infusion was used.

Results: The cost of an epidural infusion totalled $37.02, which included the cost of the epidural kit, bupivacaine solution, infusion bag, no-port tubing, and 2 ml ampule of fentanyl. The cost of a CSE without local anesthetic infusion totalled $27.67, which included the cost of the epidural kit, a 124 mm 26 g Gertie Marx needle® and sufentanil (100 mcg diluted into 10 doses). A CSE which progressed to a local anesthetic infusion was priced at $44.21, which included the costs of both an epidural infusion and CSE. During the study period, anesthesiologists were free to choose either CSE or continuous epidural infusion. CSE was performed in 63% of patients, whereas 37% received continuous infusion labor epidurals. Of the 1071 patients who received CSE, 48% delivered before a local anesthetic was initiated, whereas 52% went on to require epidural analgesia after the spinal opiate effect had subsided.

Conclusion: Prior to this study, the presumption at our hospital was that CSE was more costly than epidural analgesia for labor. However, we found that many patients who receive CSE deliver before the effect of CSE dissipates and never receive an infusion of local anesthetics. The annual cost of CSE at our institution was actually less than if all patients had received a "standard" continuous infusion epidural anesthetic. By limiting the use of CSE to multiparous patients, who are less likely to need local anesthetic supplementation, an even greater savings could be realized.