Calculation of comparative utilisation and cost: a South African perspective on intravenous vs. inhalational anaesthesia for procedures of differing duration

Abstract

Objectives: The cost of various anaesthetic techniques fluctuates and is seldom transparent, because of complicated anaesthetic protocols. The theoretical costs of different anaesthetic techniques were compared in this study. Design: This comparative study utilised protocols that determined the cost of inhalational anaesthesia, based on evidence from relevant literature. Propofol target-controlled infusion (TCI) was used as the intravenous protocol [Alaris ® PK syringe pump (Schnider model), Cardinal Health, UK]. Setting and subjects: No patients were involved in this theoretical cost analysis. Outcome measures: The calculated costs of high-vs. low-flow inhalational anaesthesia and inhalation vs. intravenous anaesthesia with propofol, with or without N 2 O, and procedures of a longer and shorter duration were compared. Results: Trends were noted. High-flow inhalational anaesthesia tended to be more expensive than low-flow inhalational anaesthesia. The savings that were gained by implementing low-flow anaesthesia increased with the duration of procedure. The savings were greater when less soluble inhaled anaesthetics were used. Isoflurane and halothane anaesthesia cost more when N 2 O was added. Inhalational anaesthesia with isoflurane was the most cost-effective option consistently. Anaesthesia with desflurane was always the most expensive option. Propofol TCI was less expensive than sevoflurane for long procedures. Conclusion: Anaesthetic drugs account for only 3-4% of the total cost of a surgical procedure, but economic use thereof frees up resources for other essentials in financially challenging times. Isoflurane should be used widely. N 2 O should probably be used conservatively as it increases the anaesthetic cost and contributes to pollution and ozone depletion. Propofol TCI can be considered instead of sevoflurane inhalational anaesthesia for longer procedures.

A randomised controlled trial comparing quality of recovery between desflurane and isoflurane inhalation anaesthesia in patients undergoing ophthalmological surgery at a tertiary hospital in South Africa (DIQoR trial)

“…Real-world data are given regarding volatile agent consumption and current cost of both desflurane and isoflurane using minimal FGF for maintenance of anaesthesia. Ryksen and Diedericks 38 in their 2012 paper mathematically calculated the cost of inhalation anaesthesia at low flow rates, using a FGF of 1 L min −1 . This FGF is more than three times higher than the median reported FGF used in our desflurane group.…”

“…This FGF is more than three times higher than the median reported FGF used in our desflurane group. Ryksen and Diedericks 38 emphasise the point that higher flow rates are associated with increased cost of inhalation anaesthesia. It would therefore make sense to limit FGF as much as possible for all agents, especially for expensive agents such as desflurane.…”

Cost-Effectiveness of Propofol (Diprivan) Versus Inhalational Anesthetics to Maintain General Anesthesia in Noncardiac Surgery in the United States

“…Other cost studies have assumed comparable equipment cost for different types of anesthesia or have not mentioned that aspect at all. [52][53][54] In addition, the longer time to respiratory recovery and tracheal extubation reported by Schraag et al 7 were not included as a separate parameter in the model since respiratory recovery and tracheal extubation are covered in our model by PACU time as an overall indicator of the post-anesthesia phase in US hospitals. As a final limitation, the economic inputs of our models were based on the US market, which limits the applicability of the results to other regions.…”

Cost identification analysis of general anesthesia

“…Provided flows are constant, nonsoluble agents, such as desflurane and sevoflurane, are costlier than isoflurane. [ 17 18 19 20 21 ] This difference is due to sevoflurane being 2.5 times costlier than isoflurane. Boldt et al .…”