Papers

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

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

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

Correspondence to: T H Rainer rainer1091{at}cuhk.edu.hk

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.