Pharmacoeconomics of Volatile Inhalational Anaesthetic Agents: An 11-Year Retrospective Analysis

Abstract

With continuously increasing expenditure on health care resources, various cost containment strategies have been suggested in regard to controlling the cost of inhalational anaesthetic agents. We performed a cost identification analysis assessing inhalational anaesthetic agent expenditure at a tertiary level hospital, along with an evaluation of strategies to contain the cost of these agents. The number of bottles of isoflurane, sevoflurane and desflurane used during the financial years 1997 to 2007 was retrospectively determined and the acquisition costs and cumulative drug expenditure calculated. Pharmacoeconomic modelling using low fresh gas flow anaesthesia was performed to evaluate practical methods of cost reduction. The use of isoflurane decreased from 384 bottles during 1997 to 204 in 2007. In contrast, use of sevoflurane increased from 226 bottles during 1998 to 875 during 2007. Desflurane use increased from 34 bottles per year during 2002 (its year of introduction) to 163 bottles per year in 2007. While the inflation-adjusted cumulative expenditure for these inhalational agents (Australian dollars) increased from $132,000 in 1997 to over $326,000 in 2007, an increase of 168%, patient workload over the same period increased by only 11%. Pharmacoeconomic modelling demonstrated that sevoflurane at 2 l/minute costs 19 times more than isoflurane at 0.5 l/minute. For the financial years 1997 to 2007, we found a progressive shift from the cheaper isoflurane to the more expensive agents, sevoflurane and desflurane, a shift associated with marked increases in costs. Low flow anaesthesia with isoflurane is one strategy to reduce costs.

Reducing Wastage of Inhalation Anesthetics Using Real-time Decision Support to Notify of Excessive Fresh Gas Flow

“…In the field of anesthesia, inhalation agents represent a major portion (20-25%) of the anesthetic drug costs, 1-3 and the potential for cost savings by reducing the use of inhalation agents has been well documented. [1][2][3][4][5][6][7][8][9][10][11][12][13][14] A sizable fraction of the administered inhalation agents is not absorbed by the patient, but rather is vented into the atmosphere through the waste gas scavenging system. The amount of wasted inhalation agent is directly correlated to the fresh gas flow (FGF).…”

Target-controlled inhalation anaesthesia: A cost-benefit analysis based on the cost per minute of anaesthesia by inhalation

“…Desflurane replaced isoflurane and sevoflurane in order to increase the turnover of patients in the recovery room [12][13][14][15]. The ratio of halogenated agent consumption for a determined fresh gas flow is linear overtime when comparing halogenated agents at the same fresh gas flow rate [16].…”

Measurement of consumption of sevoflurane for short pediatric anesthetic procedures: Comparison between dion′s method and dragger algorithm

“…[8] Conventionally weighing the vaporizer before and after use has been used,[9] but such sensitive measuring devices are not commonly available at most hospitals. Weighing after each case may also have constraints of time, equipment sensitivity and cost.…”