A Cost-Benefit Analysis of the ENIGMA Trial

Abstract

Background:The ENIGMA trial was a prospective, randomized, multicenter study that evaluated the clinical consequences of including N 2 O in general anesthesia. Patients who were given a N 2 O-free anesthetic when undergoing major surgery for which the expected hospital stay was at least 3 days had lower rates of some postoperative complications. This suggests that, despite a higher consumption of potent inhalational agent, there could be a financial benefit when N 2 O is avoided in such settings. Methods: A retrospective cost analysis of the 2,050 patients recruited to the ENIGMA trial was performed. We measured costs from the perspective of an implementing hospital. Direct health care costs include the costs for maintaining anesthesia, daily medications, hospitalization, and complications. The primary outcome was the net financial savings from avoiding N 2 O in major noncardiac surgery. Comparisons between groups were analyzed using Student t test and bootstrap methods. Sensitivity analyses were also performed. Results:Rates of some serious complications were higher in the N 2 O group. Total costs in the N 2 O group were $16,203 and in the N 2 O-free group $13,837, mean difference of $2,366 (95% CI: 841-3,891); P ϭ 0.002. All sensitivity analyses retained a significant difference in favor of the N 2 Ofree group (all P Յ 0.005). Conclusions: Despite N 2 O reducing the consumption of more expensive potent inhalational agent, there were marked additional costs associated with its use in adult patients undergoing major surgery because of an increased rate of complications. There is no cogent argument to continue using N 2 O on the basis that it is an inexpensive drug.

Economic Evaluation of Pharmacologic Pre- and Postconditioning With Sevoflurane Compared With Total Intravenous Anesthesia in Liver Surgery: A Cost Analysis

“… 46 , 47 We are not aware of another health economic evaluation, which has assessed the economic effects of pharmacologic conditioning with volatile agents in major surgical interventions. Graham et al 48 have performed health economic evaluations assessing the economic effect of N 2 O-free anesthetics. Their cost–benefit analysis showed lower treatment costs resulting from lower complication rates, although the costs of N 2 O-free anesthetics were higher when compared with the conventional procedures with N 2 O.…”

“…Their cost–benefit analysis showed lower treatment costs resulting from lower complication rates, although the costs of N 2 O-free anesthetics were higher when compared with the conventional procedures with N 2 O. 48 More health economic evaluations have to be performed to better understand the relationship between the magnitude of patient benefit and costs for innovative approaches in anesthesia. Patient blood management, for example, could be such an approach to be evaluated with sound health economic analyses.…”

Practices and opinions on nitrous oxide/oxygen sedation from dentists licensed to perform relative analgesia in Brazil

“…However, this understanding of anesthesiologists’ opposition was not a clear barrier to RA practice among Brazilian respondents, since only about half the respondents agreed that anesthesiologists’ contrary opinion on RA should limit its use by dentists. Moreover, a recent trial (ENIGMA trial) performed with anesthesiologists about the usage of nitrous oxide for general anesthesia were reported in three studies showing both positive [28] and negative [29,30] recommendations in different situations.…”

Is Bagging Effective in the Classification of Small-Sample Genomic and Proteomic Data?

“…This is distinct from the approach advocated in [5] for random forests, where unpruned, fully grown trees are used instead; the reason for this is that we did not attempt to implement the approach in [5] (which involves concepts as random node splitting and is thus specific to decision trees), but rather to study the behavior of bagging, which is the centerpiece of such ensemble methods, across different classification rules. Resampling is done by means of balanced bootstrapping, where all samples are made to appear exactly the same number of times in the computation [28]. …”