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NPJ Digit Med. 2018 Jun 13;1:22. doi: 10.1038/s41746-018-0026-4. eCollection 2018.

Economic analysis of implementing virtual reality therapy for pain among hospitalized patients.

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Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA USA.
2Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA USA.
3Division of Digestive and Liver Diseases, Cedars-Sinai Medical Center, Los Angeles, CA USA.
4Division of Informatics, Cedars-Sinai Medical Center, Los Angeles, CA USA.
5Department of Pharmacy, Cedars-Sinai Medical Center, Los Angeles, CA USA.
6Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA USA.


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.


Health care economics; Pain

Conflict of interest statement

Competing interestB.M.R.S. received a research grant, administered by his academic institution, and also received $1,250 in 2014 for a one-time activity that was unrelated to the published research, both from applied VR (Los Angeles, California). The authors otherwise have no equity, royalty, board positions, or other relevant financial relationships to disclose with appliedVR or any other company with a related product or service.

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