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This cost-effectiveness analysis, conducted alongside a randomized controlled trial, evaluates the cost-effectiveness of paravertebral analgesia compared to epidural analgesia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This multicenter randomized controlled trial across four Dutch hospitals, including 192 patients, compared epidural and paravertebral analgesia in patients undergoing MIE. Cost-effectiveness was evaluated from a healthcare perspective, including in-hospital costs only, with time horizons from initial hospital stay and 90\u00a0days postoperatively. Procedural costs were calculated with a bottom-up approach, and analgesia costs with data from the electronic case report form (eCRF). Other hospital costs were calculated using insurance claim data from hospital registries. Effectiveness was displayed as Quality of Recovery (QoR-40) scores. Bootstrapping was used to estimate uncertainty.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Mean initial surgery costs were \u20ac10,469 for the epidural and \u20ac10,051 for the paravertebral group, primarily due to a shorter mean operating room time (mean difference 19\u00a0min; 95% CI \u2212\u20097 to 45). Mean postoperative (day 1\u20133) medication costs were \u20ac116 and \u20ac125, respectively. During the initial hospital stay, mean total in-hospital costs for uncomplicated patients were \u20ac8557 and \u20ac8646, and for complicated patients \u20ac28,244 and \u20ac28,387, respectively. When excluding complications, bootstrapping showed that 47.9% of iterations had lower costs and lower effectiveness for paravertebral analgesia, with the other iterations across all other quadrants.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Cost differences between paravertebral and epidural analgesia were minimal, with cost-effectiveness primarily influenced by the slightly lower effectiveness of paravertebral analgesia.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00464-026-12642-7","type":"journal-article","created":{"date-parts":[[2026,3,4]],"date-time":"2026-03-04T15:32:15Z","timestamp":1772638335000},"page":"4056-4067","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Cost-effectiveness of Paravertebral versus EPidural analgesia in Minimally invasive Esophageal resectioN (PEPMEN): an economic evaluation alongside a randomized clinical trial"],"prefix":"10.1007","volume":"40","author":[{"given":"Cezanne D.","family":"Kooij","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kirsten","family":"Opmeer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Minke L.","family":"Feenstra","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wietse J.","family":"Eshuis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eline M.","family":"de Groot","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeroen","family":"Hermanides","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"B. 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Prof. dr. Ruurda reported serving an advisory or consulting role for Intuitive Surgical and Medtronic. Prof. dr. Luyer reported receiving research grants from Medtronic and Galvani Bioelectronics outside the submitted work. Dr. Nieuwenhuijzen reported serving a consulting or advisory role for Medtronic. Dr. Buise reported serving a consulting or advisory role for Medtronic. Dr. van Det reported serving a consulting or advisory role for Intuitive Surgical. Dr. Kouwenhoven reported serving a consulting or advisory role for Intuitive Surgical. Prof. dr. Hollmann reported serving roles as Executive Section Editor Pharmacology with Anesthesia & Analgesia, Section Editor Anesthesiology with J Clin Med, Editor with Front Physiol, and research support and honorarium for consultancy by PAION, Medical Developments & IDD Pharma. Prof. dr. van Berge Henegouwen reported serving a consulting or advisory roles for Intuitive Surgical, Viatris, Johnson & Johnson, BBraun, Stryker and Medtronic, all fees paid to the institution. Prof. dr. van Hillegersberg reported serving a consulting or advisory role for Intuitive Surgical, Medtronic and Olympus. The other authors have no conflicts of interest or financial ties to disclose.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Disclosures"}}]}}