Thoracotomy surgery is associated with high levels of acute pain and can lead to chronic post-surgical pain. Two methods of regional analgesia are commonly used in patients undergoing thoracotomy surgery, thoracic epidural blockade (TEB) and paravertebral blockade (PVB). The economic evaluation aimed to compare PVB to TEB, in terms of both costs and outcomes, and assess the cost-effectiveness of the different analgesic techniques, considering both impacts on chronic pain and health-related quality of life.

TOPIC-2 was a prospective, multi-centre, randomised, open-label, parallel-group, superiority trial of 770 adult (≥18 years old) thoracotomy patients, recruited from secondary care. The main economic analysis aimed to assess cost-effectiveness based on incremental cost per quality-adjusted life year (QALY) gained at 12 months post-randomisation, with a secondary analysis of cost per case of chronic post-thoracotomy pain (CPTP) avoided at 6 months.

The cost-utility analysis demonstrated that TEB resulted in slightly more QALYs at 12 months and was slightly more costly than PVB; however, the differences in costs and outcomes were not statistically significant at the 95% level. The results the sensitivity analyses showed that there was considerable uncertainty around the difference in costs and outcomes between the treatment groups.

The results of the analysis support the findings of other studies which suggest that there is no difference in the incidence of CPTP between patients receiving PVB compared with TEB and provides additional insights on health-related quality of life and costs. The study provides important information around chronic post-operative pain for policy makers, clinicians and patients.

The authors have declared no competing interest.

NCT03677856

This project was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment (HTA) programme (NIHR 16/111/111)

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Ethics committee of South-East Scotland Research Ethics Committee (REC 18/SS/0131) gave ethical approval for this work.

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Postal address: Health Economics Unit, Department of Applied Health Sciences, College of Medicine and Health, IOEM Building, Edgbaston, Birmingham B15 2TT

Postal address: School of Health Sciences, Public Health Building, College of Medicine and Health, University of Birmingham, Birmingham, B15 2TT

Postal address: Regent Court, 30 Regent Street, Sheffield S1 4DA

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Postal address: Heol Maes Eglwys, Cwmrhydyceirw, Swansea, SA6 6NL

Postal address: Pain Research Institute, University of Liverpool, ILCAMS, Clinical Sciences Centre, Liverpool L9 7AL

Postal address: Department of Cardiothoracic Surgery, Morriston Hospital, Heol Maes, Eglwys, Swansea, Wales, SA6 6NL

Postal address: Department of Anaesthesia, University Hospital Birmingham, Mindelsohn Way, Birmingham B15 2GW

Postal address: Heart Science Centre, Harefield Hospital, Hill End Rd, Harefield, Uxbridge UB9 6JH

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Postal address: University Hospitals Birmingham, Mindelsohn Way, Birmingham BI52GW

Postal address: Institute of Inflammation and Ageing, College of Medical and Dental Sciences Centre for translational Inflammation Research, University of Birmingham Laboratories Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham B15 2TT

Postal address: Cardiothoracic Critical Care Unit, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Southmoor Road, Manchester M23 9LT

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Postal address: Institute of Inflammation and Ageing, College of Medical and Dental Sciences Centre for translational Inflammation Research, University of Birmingham Laboratories Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham B15 2TT

The datasets generated during the current study will be made available by the Chief Investigator upon reasonable request and in accordance with the Birmingham Clinical Trials Unit's research collaboration and data transfer guidelines.