Abstract
ObjectivesIt is not known whether using propofol total intravenous anaesthesia (TIVA) to reduce incidence of postoperative nausea and vomiting (PONV) is cost-effective. We assessed the economic impact of propofol TIVA versus inhalational anesthesia in adult patients for ambulatory and inpatient procedures relevant to the US healthcare system. MethodsTwo models simulate individual patient pathways through inpatient and ambulatory surgery with propofol TIVA or inhalational anesthesia with economic inputs from studies on adult surgical US patients. Efficacy inputs were obtained from a meta-analysis of randomized controlled trials. Probabilistic and deterministic sensitivity analyses assessed the robustness of the model estimates. ResultsLower PONV rate, shorter stay in the post-anesthesia care unit, and reduced need for rescue antiemetics offset the higher costs for anesthetics, analgesics, and muscle relaxants with propofol TIVA and reduced cost by 11.41 ± 10.73 USD per patient in the inpatient model and 11.25 ± 9.81 USD in the ambulatory patient model. Sensitivity analyses demonstrated strong robustness of the results. ConclusionsMaintenance of general anesthesia with propofol was cost-saving compared to inhalational anesthesia in both inpatient and ambulatory surgical settings in the United States. These economic results support current guideline recommendations, which endorse propofol TIVA to reduce PONV risk and enhance postoperative recovery.
Highlights
In most of the 321.5 million surgical procedures conducted worldwide each year,[1] patients receive total intravenous anaesthesia (TIVA) with propofol or inhalational anesthesia with volatile anesthetics
Lower postoperative nausea and vomiting (PONV) rate, shorter postanesthesia care unit (PACU) stay, and reduced need for rescue antiemetics with propofol-based TIVA resulted in a cost reduction of 11.41 6 10.73 USD per patient compared to inhalational anesthesia
The incremental cost-effectiveness ratio (ICER) was estimated at USD -107.5 per PONV averted, which means every PONV episode avoided with propofol was associated with a reduction in the cost of anesthesia of USD 107.5 per patient
Summary
In most of the 321.5 million surgical procedures conducted worldwide each year,[1] patients receive total intravenous anaesthesia (TIVA) with propofol or inhalational anesthesia with volatile anesthetics. The choice between TIVA and inhalational anesthesia is often based on regional and institutional preferences, even though in recent years, the environmental impact of inhalational anesthesia has received increasing recognition.[2] this may not reflect best practice,[3] because evidence shows that the anesthetic agent may influence patient outcomes, such as postoperative pain,[4] postoperative cognitive dysfunction,[5] emergence agitation,[6] and postoperative nausea and vomiting (PONV).[7] the most comprehensive metaanalysis investigating patient-relevant postoperative outcomes with propofol and inhalational agents to date reported a 39% lower relative risk for PONV, lower pain scores after extubation, and shorter time spent in the postanesthesia care unit (PACU) associated with propofol-based TIVA.[7]. A recent systematic review on cost-effectiveness research in anesthesiology concluded that there
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