Costs and wastes in anesthesia care

Abstract

Purpose of review: The current economic climate has put pressure on healthcare systems and providers, including anesthesiologists, to minimize costs without sacrificing patient safety. In this review, we discuss costs associated with anesthesia care, including medications and intraoperative monitoring, and suggest ways to reduce wastes and overall expenditure.

Recent findings: Significant amount, perhaps 20-50%, of drugs drawn up are never used but discarded as whole ampoules or vials. There has been a progressive shift to using more expensive inhalational agents and total intravenous anesthesia in the last 10 years. Highest drug costs are associated with total intravenous anesthesia protocols, which are five to 10 times more expensive than administering sevoflurane or desflurane with premedication using antiemetics. Among the inhalational agents, usage costs of sevoflurane and desflurane are 10 and 25 times, respectively, that of isoflurane. Bispectral index monitoring, which requires use of an expensive proprietary electrode is no better, perhaps even less effective, than titration of inhalational agents using end tidal anesthetic concentration to monitor depth of anesthesia and prevent intraoperative awareness.

Summary: Anesthesia medications comprise a significant proportion of hospital pharmacy budgets. Average anesthesia-related cost reductions of US$ 13-30 per cases multiplied by 25 million anesthetics administered annually in the USA has the potential to yield savings of US$ 350-750 million. Bispectral index monitoring during inhalational anesthesia adds to the cost without providing any benefit.