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Anesth Analg 2000;91:1170-1175
© 2000 International Anesthesia Research Society

INTRAVENOUS ANESTHESIA

Part II: Total Episode Costs in a Randomized, Controlled Trial of the Effectiveness of Four Anesthetics

Terri Jackson, MA, PhD*, and Paul S. Myles, MB BS, MPH, MD, FFARCSI, FANZCA{dagger}

*Hospital Services Research Group, Monash University Health Economics Unit, West Heidelberg; and {dagger}Department of Anaesthesia and Pain Management, Alfred Hospital, Prahan, Australia

Address correspondence and reprint requests to Terri Jackson, MA, PhD, Hospital Services Research Group, Monash Health Economics Unit, PO Box 477, W. Heidelberg, VIC 3081, Australia. Address e-mail to terri.jackson{at}buseco.monash.edu.au

Newer anesthetics promise improved clinical outcomes, but usually come at a higher price per dose. Previous studies have found few economic benefits in the immediate postoperative period, but have hypothesized that earlier recovery may lead to lower costs for the whole episode of hospitalization. This study uses cost data for patients enrolled in a randomized, controlled clinical trial comparing four anesthetics to test whether the higher costs of the newer anesthetics would be offset against decreased use of other hospital resources. Five hundred general surgery patients were randomly assigned to one of four anesthetic regimens. Estimates from the hospital’s patient costing system were used, with validated cost records for a subset of 360 patients. Five patients admitted to the intensive care unit or requiring prolonged hospitalization skewed the distribution of costs, but none of these complications could be attributed to anesthesia. No significant differences were found on length of stay, mean episode cost, operating room costs, ward costs, or readmission rate within 3 mo. The study was not powered to sufficiently show differences in intensive care unit admission or other uncommon outcomes. Patient quality of recovery did not vary among groups, but neither patient willingness-to-pay nor satisfaction were directly measured.

Implications: Propofol and sevoflurane do not offer any significant economic advantages over thiopental and isoflurane in adults undergoing elective inpatient surgery.






Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press
Copyright © 2000 by the International Anesthesia Research Society.