Role of the anesthesiologist in the wider governance of healthcare and health economics

Martin, Janet; Cheng, Davy

doi:10.1007/s12630-013-9994-7

Cited by 16 publications

(13 citation statements)

References 24 publications

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“…20 In this way, best practices can be defined among anesthesia departments based on the measurement of both cost and evidence-based benefit. In our study, we observed a decrease in cost with minimal changes in outcomes.…”

Section: Discussionmentioning

confidence: 99%

Limiting the accessibility of cost-prohibitive drugs reduces overall anesthetic drug costs: a retrospective before and after analysis

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Ehrenfeld

Wanderer

2015

Can J Anesth/J Can Anesth

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Purpose Cost effectiveness is becoming increasingly important in today's healthcare environment. Remifentanil, dexmedetomidine, and desflurane are costly agents that often have suitable alternatives to their use. We sought to identify changes in cost and outcomes following interventions that limited the availability of these drugs. Methods We calculated anesthetic drug costs for all operating room procedures performed before and after the accessibility interventions. We retrospectively compared drug costs per case and the frequency of agent use before and after the interventions. In addition, we analyzed the incidence of adverse outcomes, including delayed outof-room times, postoperative nausea and vomiting (PONV), unplanned intubations, use of naloxone, and reintubations. Wilcoxon-Mann-Whitney and Chi square analyses were used to quantify differences in cost, use, and outcomes between cohorts. Results Of the 27,233 cases we identified, 24,201 cases were analyzed. The mean anesthetic drug costs per case were significantly lower after the interventions vs before at ($21.44 vs $32.39, respectively), a cost savings of $10.95 (95% confidence interval, $9.86 to $12.04; P \ 0.001). Additionally, a comparison of data after vs before the interventions revealed the following results: remifentanil use was significantly lower (3.5% vs 9.2% of cases; P \ 0.001). Dexmedetomidine use did not differ significantly (0.4% vs 0.5% of cases; P = 0.07), and desflurane use was significantly lower (0.6% vs 20.2% of cases; P \ 0.001). There was no significant relationship between the interventions and the frequency of delayed out-of-room times (15.5% vs 15.9%; P = 0.41), unplanned intubations (0.02% vs 0.03%; P = 0.60), and reintubations (0.01% vs 0.03%; P = 0.28). Postoperative nausea and vomiting decreased significantly after the interventions (22.8% vs 24.4%; P = 0.003), and naloxone use showed a significant increase (0.22% vs 0.11% of cases; P = 0.04). Conclusions Reducing the accessibility of these costprohibitive agents resulted in significant anesthetic drug cost savings and decreased utilization of remifentanil and desflurane. The interventions had no significant effect on patient recovery time, incidence of unplanned intubations, or incidence of reintubation, but they were associated with a decrease in PONV and an increase in naloxone use. Résultats Sur les 27 233 cas identifiés, nous avons analysé 24 201 cas. Le coût moyen par cas des médicaments anesthésiques était significativement plus bas après avoir limité l'accès, par rapport à avant (21,44 $ vs 32,39 $, respectivement), soit une économie de 10,95 $ par cas (intervalle de confiance 95 %, 9,86 $ à 12,04 $; P \ 0,001). De plus, la comparaison des données après vs. avant a révélé les éléments suivants : l'utilisation du rémifentanil était significativement plus basse (3,5 % vs 9,2 % des cas; P \ 0,001); il n'y a pas eu de différence significative dans l'utilisation de la dexmédétomidine (0,4 % vs 0,5 % des cas; P = 0,07); et l'utilisation du desflurane était signif...

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Section: Discussionmentioning

confidence: 99%

Limiting the accessibility of cost-prohibitive drugs reduces overall anesthetic drug costs: a retrospective before and after analysis

Tabing

Ehrenfeld

Wanderer

2015

Can J Anesth/J Can Anesth

View full text Add to dashboard Cite

show abstract

“…If value is the goal, the most relevant question when choosing between anesthetic drugs is whether the most expensive agents provide a margin of benefit that is worthy of the additional cost. 1 Meta-analyses found no difference in clinical or resource outcomes when comparing desflurane, dexmedetomidine, or remifentanil with active comparators. 6 - 14 Many of the proposed statistically significant benefits of more costly anesthetic agents, such as faster emergence from anesthesia, do not translate into clinically important benefits in terms of real reductions in morbidity and resource utilization.…”

Section: Value Rather Than Costmentioning

confidence: 98%

“…To appreciate cost containment initiatives, we need to understand the foundational metrics of health economics: cost-minimization, cost-effectiveness, cost-utility, and cost-benefit analysis. 1 In particular, we need to understand that costs and cost analyses are not bona fide health economic analyses since they provide just one side of the equation, i.e., costs only. In healthcare, costs alone are not enough; we are often willing to pay increasingly more for increasingly better outcomes.…”

Section: Role Of Health Economic Analysismentioning

confidence: 99%

“…Health economic analysis involves calculating a value equation to estimate the cost-effectiveness of alternative options, either through cost-effectiveness analysis (i.e., the incremental cost required to achieve an incremental benefit for drug A vs drug B, expressed as ∆C/∆E) or through cost-utility analysis (i.e., the incremental cost required to achieve an incremental quality-adjusted life year for drug A vs drug B expressed as ∆C/∆QALY). 1 Cost-minimization analysis, on the other hand, is a special type of cost-effectiveness analysis where the alternatives are considered equivalent (and hence ∆E cancels out to zero), and only the difference in costs remains relevant (∆C). In this special case of equivalence, costs alone suffice for decisions about cost-effectiveness.…”

Section: Role Of Health Economic Analysismentioning

confidence: 99%

“…Proactive and strategic approaches require that we systematically review the cumulating evidence and continuously estimate the relative cost effectiveness of our options while being open to disinvest from things that are no longer worthy of our limited resources. 1 …”

Section: Value Rather Than Costmentioning

confidence: 99%

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