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Departments of Anesthesiology and Critical Care Medicine; Mayo Clinic; Jacksonville, FL; bloomfield.eric{at}mayo.edu
To the Editor:
The study by Schuster et al. (1) comparing the costs of three different regional anesthesia techniques with general anesthesia according to duration of surgical procedure, although a retrospective comparison, was an admirable evaluation.
Although cost does need to be considered, sights should be set on a more opportunistic analysis. Costs are only one component. Cost per unit of output should be part of the bigger picture. The specialty of anesthesiology is now involved in perioperative medicine, and anesthesiologists participate more often in the preoperative and postoperative care of patients. Costs per unit of quality-adjusted life years should be analyzed to obtain the most accurate answer to whether less expensive or more expensive costs are justified.
In the United States alone, the health care economy is more than $1 trillion (2). Technology contributes to 40% of health care inflation, yet that fact seems to be ignored. The current solution to the problem seems to be either decreasing reimbursement or denying health care services. Schuster et al. (1) stated that the cost advantage of spinal anesthesia over general anesthesia tends to decrease as the duration of the procedure lengthens. That difference may be important. However, that cost needs to be evaluated in terms of the final follow-up outcomes of patients. This approach is basic technology assessment. Knowledge of whether a treatment, drug, or procedure is less than $50,000 per quality-adjusted life years saved will allow physicians to determine whether the best financial and medical result is being obtained in the United States or elsewhere in the world. My compliments to the authors. My hope is that all physicians do long-term follow-up studies to determine whether the techniques we render to our patients make a true difference in long-term outcome.
References
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