Pharmaco-economics of anaesthetic drugs in day-case surgery — a cost-effectiveness model for anti-emetic drugs

Abstract

An increasing amount of surgery is now being performed on an ambulatory (day-case) basis. With the advent of newer shorter acting agents, it is possible to titrate the depth of anaesthesia to a desired level, achieve rapid awakening at the end of the operation and thereby ensure an early discharge of the outpatient surgical patient. However, the incidence of postoperative nausea and vomiting (PONV), a major cause of delayed discharge and unanticipated admission to hospital, remains high, in spite of the availability of anti-emetic therapy. 1-3 Although the recent introduction of anti-serotonin agents such as ondansetron has improved our ability to prevent and/or treat PONV, 4-7 the high costs of these newer agents along with the limited efficacy and side effects of older drugs (droperidol and metoclopramide) make it unclear what is the best strategy for preventing and treating PONV. 8,9 Before a new drug can replace existing ones, it is essential to demonstrate both efficacy and some advantage associated with the preferential use of the new drug (e.g. improved safety profile or duration of action). Similarly, the role of newer anaesthetic agents in day-case anaesthesia is still undetermined) In an era of limited resources, it is important to identify, measure and compare the costs, risks and benefits to determine which alternative agent provides the best outcome for the resources invested. This examination of the economic consequences of the use of a drug had led to the development of a separate branch of pharmacology termed pharmaco-economics. 1° In this article, we have reviewed the terminology and methodological issues associated with the pharmaco-economic evaluation of anaesthetic