Abstract
Virtual reality (VR) has emerged as a novel and effective non-pharmacologic therapy for pain, and there is growing interest to use VR in the acute hospital setting. We sought to explore the cost and effectiveness thresholds VR therapy must meet to be cost-saving as an inpatient pain management program. The result is a framework for hospital administrators to evaluate the return on investment of implementing inpatient VR programs of varying effectiveness and cost. Utilizing decision analysis software, we compared adjuvant VR therapy for pain management vs. usual care among hospitalized patients. In the VR strategy, we analyzed potential cost-savings from reductions in opioid utilization and hospital length of stay (LOS), as well as increased reimbursements from higher patient satisfaction as measured by the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. The average overall hospitalization cost-savings per patient for the VR program vs. usual care was $5.39 (95% confidence interval –$11.00 to $156.17). In a probabilistic sensitivity analysis across 1000 hypothetical hospitals of varying size and staffing, VR remained cost-saving in 89.2% of trials. The VR program was cost-saving so long as it reduced LOS by ≥14.6%; the model was not sensitive to differences in opioid use or HCAHPS. We conclude that inpatient VR therapy may be cost-saving for a hospital system primarily if it reduces LOS. In isolation, cost-savings from reductions in opioid utilization and increased HCAHPS-related reimbursements are not sufficient to overcome the costs of VR.
Highlights
Effective pain management among hospitalized patients is associated with better health outcomes[1] and increased patient satisfaction.[2]
In light of the need for alternative non-pharmacologic pain management and the growing use of virtual reality (VR) in healthcare and medicine, we assessed the economic implications of implementing an inpatient VR therapy program for acute pain management
Our results demonstrate that VR therapy may be cost-saving for a hospital system and delineate cost and effectiveness thresholds
Summary
Effective pain management among hospitalized patients is associated with better health outcomes[1] and increased patient satisfaction.[2]. We found that while few inpatients were both eligible and willing to use VR, those that used VR reported that it was a positive experience and that it improved their pain and anxiety.[21] In a separate study, we found that 65% of hospitalized patients receiving a VR experience achieved a clinically significant pain response vs 40% of controls watching a relaxation video (p = 0.01; number needed to treat = 4) without any adverse events reported.[22] Given the effectiveness of VR therapy for pain management, VR as an adjunctive non-pharmacologic pain therapy program has potential to reduce opioid utilization.[23] Other possible benefits of inpatient VR therapy include reduction in hospital LOS and increased patient satisfaction.[24,25] While the use of VR in the hospital is promising, no study to our knowledge has yet examined the cost and effectiveness thresholds required for an inpatient VR program to be cost-saving. The probability of patients selecting the best possible answers on the HCAHPS survey had the least impact on the outcome of the model
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