Early health economic analysis of virtual reality therapy for pain management after surgery.

introductionVirtual reality (VR) therapy is increasingly used to mitigate pain and anxiety in inpatient settings, with varying effectiveness in postoperative settings. The costs of VR therapy also differ among suppliers. This health-economic analysis aims to inform policy- and decision-makers on the potential impact of VR therapy from a societal perspective based on pain management at discharge and the development of chronic postsurgical pain (CPSP).

methodsA Markov model was developed to simulate 1-year postoperative costs and effects. Using a threshold and headroom analysis, the Incremental Cost-effectiveness Ratio (ICER) was calculated for various VR effectiveness estimates and costs when VR therapy demonstrated cost-effectiveness or cost-savings for postoperative pain management. VR effectiveness was based on opioid use at discharge, affecting the Markov model's initial distribution and CPSP development. The ICER was calculated from quality-adjusted life-years (QALYs) and costs associated with CPSP. A univariate sensitivity analysis was used to assess parameter uncertainty by varying each parameter by ±20% from the base-case value.

resultsVR therapy needs to reduce opioid use at discharge by at least 2.8% to be cost-effective at a willingness-to-pay threshold of €20 000 per QALY and VR costs of €47.48 per patient. To be cost-saving, a reduction of at least 6.5% is needed. The sensitivity analysis indicated that the transition probability from "pain with opioid" to "pain free" in month 2 had the most impact on the ICER. Other significant variables included VR effectiveness and costs, each influencing the ICER by over €5000.

conclusionThe needed 2.8% reduction in opioid use at discharge seems plausible based on literature. However, knowledge gaps regarding the effectiveness of VR, the incidence of chronic postoperative pain, and societal costs of chronic pain need to be addressed, to better understand VR therapy's role in optimizing postoperative pain management.