Anesthetic Drug Costs Research Articles

Sources of Variation in Anesthetic Drug Costs.

Increasing attention has been focused on health care expenditures, which include anesthetic-related drug costs. Using data from 2 large academic medical centers, we sought to identify significant contributors to anesthetic drug cost variation. Using anesthesia information management systems, we calculated volatile and intravenous drug costs for 8 types of inpatient surgical procedures performed from July 1, 2009, to December 31, 2011. For each case, we determined patient age, American Society of Anesthesiologists (ASA) physical status, gender, institution, case duration, in-room provider, and attending anesthesiologist. These variables were then entered into 2 fixed-effects linear regression models, both with logarithmically transformed case cost as the outcome variable. The first model included duration, attending anesthesiologist, patient age, ASA physical status, and patient gender as independent variables. The second model included case type, institution, patient age, ASA physical status, and patient gender as independent variables. When all variables were entered into 1 model, redundancy analyses showed that case type was highly correlated (R = 0.92) with the other variables in the model. More specifically, a model that included case type was no better at predicting cost than a model without the variable, as long as that model contained the combination of attending anesthesiologist and case duration. Therefore, because we were interested in determining the effect both variables had on cost, 2 models were created instead of 1. The average change in cost resulting from each variable compared to the average cost of the reference category was calculated by first exponentiating the β coefficient and subtracting 1 to get the percent difference in cost. We then multiplied that value by the mean cost of the associated reference group. A total of 5504 records were identified, of which 4856 were analyzed. The median anesthetic drug cost was $38.45 (25th percentile = $23.23, 75th percentile = $63.82). The majority of the variation was not described by our models-35.2% was explained in the model containing case duration, and 32.3% was explained in the model containing case type. However, the largest sources of variation our models identified were attending anesthesiologist, case type, and procedure duration. With all else held constant, the average change in cost between attending anesthesiologists ranged from a cost decrease of $41.25 to a cost increase of $95.67 (10th percentile = -$19.96, 90th percentile = +$20.20) when compared to the provider with the median value for mean cost per case. The average change in cost between institutions was significant but minor ($5.73). The majority of the variation was not described by the models, possibly indicating high per-case random variation. The largest sources of variation identified by our models included attending anesthesiologist, procedure type, and case duration. The difference in cost between institutions was statistically significant but was minor. While many prior studies have found significant savings resulting from cost-reducing interventions, our findings suggest that because the overall cost of anesthetic drugs was small, the savings resulting from interventions focused on the clinical practice of attending anesthesiologists may be negligible, especially in institutions where access to more expensive drugs is already limited. Thus, cost-saving efforts may be better focused elsewhere.

Cochlear implantation under conscious sedation with local anesthesia; Safety, Efficacy, Costs, and Satisfaction

Objective: To evaluate the safety, efficiency, cost effectiveness, and satisfaction of patients undergoing cochlear implantation under conscious sedation versus general anesthesia.Study design: Retrospective case review of 20 patients who underwent cochlear implantation under conscious sedation which was compared to 20 age-matched patients where surgery was performed under general anesthesia.Methods: Perioperative times, length of stay, anesthesia drug costs, postoperative complications, and patient satisfaction were compared between the two groups.Results: Conscious sedation was associated with decreased drug costs, surgery time, and anesthesia time. Length of stay was significantly longer for patients undergoing general anesthesia. Patient satisfaction was superior with conscious sedation. Perioperative morbidity was not significantly different between the two groups.Conclusion: Conscious sedation for cochlear implantation is a safe, efficient, and cost-effective alternative to general anesthesia. The efficacy of conscious sedation for cochlear implant surgery may expand the treatment of profound hearing loss to the elderly who are deemed too sick for general anesthesia or are fearful of the cognitive or medical consequences of general anesthesia.

Limiting the accessibility of cost-prohibitive drugs reduces overall anesthetic drug costs: a retrospective before and after analysis.

Cost effectiveness is becoming increasingly important in today's healthcare environment. Remifentanil, dexmedetomidine, and desflurane are costly agents that often have suitable alternatives to their use. We sought to identify changes in cost and outcomes following interventions that limited the availability of these drugs. We calculated anesthetic drug costs for all operating room procedures performed before and after the accessibility interventions. We retrospectively compared drug costs per case and the frequency of agent use before and after the interventions. In addition, we analyzed the incidence of adverse outcomes, including delayed out-of-room times, postoperative nausea and vomiting (PONV), unplanned intubations, use of naloxone, and reintubations. Wilcoxon-Mann-Whitney and Chi square analyses were used to quantify differences in cost, use, and outcomes between cohorts. Of the 27,233 cases we identified, 24,201 cases were analyzed. The mean anesthetic drug costs per case were significantly lower after the interventions vs before at ($21.44 vs $32.39, respectively), a cost savings of $10.95 (95% confidence interval, $9.86 to $12.04; P < 0.001). Additionally, a comparison of data after vs before the interventions revealed the following results: remifentanil use was significantly lower (3.5% vs 9.2% of cases; P < 0.001). Dexmedetomidine use did not differ significantly (0.4% vs 0.5% of cases; P = 0.07), and desflurane use was significantly lower (0.6% vs 20.2% of cases; P < 0.001). There was no significant relationship between the interventions and the frequency of delayed out-of-room times (15.5% vs 15.9%; P = 0.41), unplanned intubations (0.02% vs 0.03%; P = 0.60), and reintubations (0.01% vs 0.03%; P = 0.28). Postoperative nausea and vomiting decreased significantly after the interventions (22.8% vs 24.4%; P = 0.003), and naloxone use showed a significant increase (0.22% vs 0.11% of cases; P = 0.04). Reducing the accessibility of these cost-prohibitive agents resulted in significant anesthetic drug cost savings and decreased utilization of remifentanil and desflurane. The interventions had no significant effect on patient recovery time, incidence of unplanned intubations, or incidence of reintubation, but they were associated with a decrease in PONV and an increase in naloxone use.

Comparing Patient Satisfaction and Intubating Conditions Using Succinylcholine or Low-Dose Rocuronium for Rigid Bronchoscopy: A Randomized Study

Despite its serious side effects, succinylcholine is commonly used for neuromuscular relaxation in short procedures, such as rigid bronchoscopy and tracheobronchial interventions. The application of low-dose rocuronium reversed by low-dose sugammadex might be a modern alternative. The aim of this study was to compare patient satisfaction, incidence of postoperative myalgia (POM) as well as intubating conditions of these two muscle relaxants for rigid bronchoscopy. A single-center, prospective-randomized, blinded study of 95 patients, scheduled for rigid bronchoscopy and tracheobronchial intervention was conducted. The patients were anesthetized with propofol, remifentanil and either low-dose succinylcholine (S) (0.5 mg/kg) or low-dose rocuronium (0.25 mg/kg) with sugammadex (RS) (0.5 mg/kg). All patients were evaluated on the first and second postinterventional day for their satisfaction with the treatment (rigid bronchoscopy) using a Numeric Analog Rating Scale (NAS 0-10) and the presence and severity of POM (NAS 1-4). Intubating conditions were assessed as excellent, good, or poor on the basis of position of vocal cords and reaction to insertion of the rigid bronchoscope. Patients in the S group were less satisfied with the treatment than patients in RS group (72.7 vs. 93.7%, p = 0.007). The incidence of POM on the first day after intervention was significantly higher in the S group then in the RS group (56.9% vs. 4.3%, p < 0.001). Although the intubation was faster (p < 0.001) and the intubating conditions significantly superior (p < 0.003) with succinylcholine, acceptable conditions were also achieved with low-dose rocuronium in 75% of patients. The anesthetic drug costs were significantly higher in the RS group then in the S group (p < 0.001). The results suggest that low-dose rocuronium provided better patient satisfaction and less POM. But with the use of low-dose succinylcholine, the intubating conditions are more comfortable, and it is less expensive than rocuronium/sugammadex.

A randomized controlled trial comparing results of closed reduction and plaster immobilization versus external fixator in unstable fractures of distal radius

To evaluate the functional and radiological outcome of the two different modalities in unstable fracture distal end of radius, and the complications in each group. Study consists of prospective analysis of the cases of unstable fracture of distal end of radius managed by two different methods of treatment in 40 patients and the functional outcome measured by the standardized functional scoring method (Gartland and Werley 1951, Stewart et al. 1984). The radiological outcome of the fracture management as mentioned above measured according to Anatomical scoring method (Stewart et al. 1984). In this study there was no statistical difference between functional and anatomical outcome when treated by either method. There was no poor graded result anatomically or functionally in either group. No serious complication was noted in both the groups. Both the method of treatment produced no significant difference in outcome, functionally and anatomically , but the extra cost of anaesthetic drugs, operation theatre charges, hazards of anaesthesia and the cost of implants can be avoided in cases managed with closed reduction and immobilization in plaster cast. Journal of College of Medical Sciences-Nepal,2011,Vol-7,No-4, 20-27 DOI: http://dx.doi.org/10.3126/jcmsn.v7i4.6737

Does anesthesiology residency training result in decreasing intraoperative drug cost from a resident’s first to second month’s experience in adult cardiac anesthesiology?

All physicians bear the responsibility of minimizing cost while providing care that meets or exceeds national quality benchmarks. Intraoperative anesthetic drug costs constitute a small but significant fraction of the total cost in the perioperative period. Previous studies have revealed that anesthesiologists are generally unaware of drug costs. In order to determine if experience and education improve anesthetic drug cost containment, we compared the total anesthetic drug cost per case as residents progressed through their rotations in cardiac anesthesia. We considered the total anesthetic drug cost for 202 adult cardiac cases, including coronary artery bypass grafting, mitral valve repair/replacement, and aortic valve repair/replacement. 77 of the cases analyzed were done by residents in their first month of cardiac anesthesia, and 125 were done by residents in their second month of cardiac anesthesia. In the interval between these rotations, residents participate in didactics and other educational activities including a practice management rotation in the CA-3 year where they are exposed to financial topics in healthcare. The average total drug cost per case for residents in their first month was $193.50; SD= $82.00. The average total cost per case for residents in their second month was $223.30; SD=$96.10. With multivariate analysis considering case type, length of procedure and patient age, the resident training level did not impact the cost in a significant way (p=0.062). In the multivariate analysis considering case type, length of procedure and patient age, more experienced residents did not have a significantly different total drug cost per case. This finding suggests that didactic educational efforts and implicit modeling over time did not reduce drug costs in the operating room during adult cardiac surgery.

Teaching systems-based competency in anesthesiology residency: development of an education and assessment tool.

The Accreditation Council for Graduate Medical Education requires programs to educate and evaluate residents in 6 competencies, including systems-based practice. We designed a survey and assessment tool to address the competency as it pertains to anesthetic drug costs in an academic center. Residents, certified registered nurse anesthetists, and faculty were asked to complete an anesthetic drug-cost survey without relying on reference materials. After a combination of compulsory in-class didactic sessions and web-based education, the participants were asked to design an anesthetic, give example cases, and determine costs. The initial task was repeated 1year later. Our preintervention survey revealed that most practitioners knew very little about anesthetic drug costs, regardless of level of training or degree. All residents completed the mandatory online education tool, more than 80% attended the departmental grand rounds program, and 100% met the goal of designing an anesthetic for all cases within the preset price limit. A repeat of the cost estimate produced an improvement in cost estimates with reduction in variability (P < .05, Student unpaired t test), although estimates of volatile anesthetic and reversal agent costs did not achieve significance at the .05 level for any of the 3 cases. Introducing a formalized teaching and assessment tool has improved our residents' understanding of anesthetic drug costs, and improved our ability to teach and assess the systems-based practice competency.

Cost awareness among anesthesia practitioners at one institution

Study Objective To characterize the accuracy of clinician knowledge of anesthesia drug and equipment costs at one institution. Design Anonymous survey instrument. Setting Large academic medical center. Measurements 130 questionnaires were sent to departmental practitioners, including residents, CRNAs, and attendings. An updated list of acquisition costs for commonly used drugs and equipment is posted on our departmental website and is sent to all clinical staff by electronic mail annually. For each item, the respondent was given a choice of price ranges and indicated the range in which they believed the actual cost of the item to be. Accuracy was calculated as the difference between the identifier of the correct and chosen ranges. The mean and variance of these differences were then calculated for each item within each practitioner group and tested to identify statistically significant differences among practitioner groups. Main Results A total of 103 (79%) completed questionnaires were received. Many practitioners overestimated or underestimated the actual costs of most of the items. There was no significant difference between the groups for the mean accuracy across the entire set of items. For variance in price estimation, there was a statistically significant greater variance only for CA1 residents compared with attendings, CRNAs, and CA3 residents. Conclusions Many experienced practitioners in an academic setting lack accurate knowledge of the acquisition costs of common drugs and supplies.

Spinal Versus General Anesthesia for Orthopedic Surgery: Anesthesia Drug and Supply Costs

Total hip or knee replacement surgeries are common orthopedic interventions that can be performed with spinal anesthesia (SA) or general anesthesia (GA). No study has investigated the economic aspects associated with the two anesthetic techniques for this common surgery. We randomized 40 patients to receive either SA or GA and analyzed the drug and supply costs for anesthesia und recovery. Anesthesia-related times, hemodynamic variables, and pain scores were also recorded. Total costs per case without personnel costs were almost half in the SA group compared with the GA group; this was a result of less cost for anesthesia (P < 0.01) and for recovery (P < 0.05). This finding was supported by a sensitivity analysis. There were no relevant differences regarding anesthesia-related times. Patients in the GA group were admitted to the postanesthesia care unit with a higher pain score and needed more analgesics than patients in the SA group (both P < 0.01). We conclude that SA is a more cost-effective alternative to GA in patients undergoing hip or knee replacement, as it is associated with lower fixed and variable costs. Moreover, SA seems to be more effective, as patients in the SA group showed lower postoperative pain scores during their stay in the postanesthesia care unit.

Cost consciousness among anaesthetic staff.

Anaesthetists, like all other specialists, need to be aware of the costs of drugs, fluids and disposables commonly used in their clinical practice so that excessive costs and waste can be minimized without compromising patient care or safety. The present study describes cost consciousness among 120 anaesthetic staff members in two Danish anaesthetic departments. A prospective study questioning 120 anaesthetic staff members (69 anaesthetic nurses, 35 senior anaesthetists and 16 junior anaesthetists) about the costs of 29 drugs, fluids and disposable used in routine anaesthetic practice. After the study period 107 questionnaires (90%) were available for analysis. Thirty-eight percent of all estimated costs were within 50% of the actual costs and 85% were within 100%. The costs of relatively expensive items such as isoflurane, enflurane, sevoflurane and hydroxyethyl starch were consistently underestimated, whereas cheaper items such as narcotic drugs, endotracheal tubes, intravenous tubing, plastic syringes and Quincke spinal needle were consistently overestimated. In general, the anaesthetic staff overestimated the costs by 69% (range -24% to 270%). The anaesthetic nursing group overestimated the costs by 49% (range -24% to 270%), junior anaesthetists by 94% (range 25% to 226%) and senior anaesthetists by 72% (range -14% to 135%). This study shows that the overall consciousness of the costs of anaesthetic drugs, fluids and disposables has to be improved in order to permit the staff to optimize resources.

Cost Per Unit

Cost Per Unit

Feedback control of anaesthesia

Feedback control of anaesthesia can improve the quality of patient care while reducing the administration and cost of anaesthetic drugs. Systems have been available for several years to control blood pressure and neuromuscular blockade. Control of anaesthetic depth has been reported using the median frequency of the electroencephalogram. Recently, the monitoring of anaesthetic depth using the bispectral index or auditory evoked potentials has greatly improved feedback control of the depth of anaesthesia.

Benchmarking the perioperative process: III. Effects of regional anesthesia clinical pathway techniques on process efficiency and recovery profiles in ambulatory orthopedic surgery

Study Objectives: (1) To incorporate regional anesthesia options for common outpatient orthopedic surgery into clinical pathways; (2) to use the clinical pathway format and the Procedural Times Glossary published by the Association of Anesthesia Clinical Directors (AACD) as management tools to measure postoperative same-day surgery processes and discharge outcomes; and (3) to determine the effects of general, regional, and combined general-regional anesthesia on these processes and outcomes. Design: Hospital database and patient chart review of consecutive patients undergoing anterior cruciate ligament reconstruction (ACLR) during academic years (AY) 1995–1996 and 1996–1997. Patient data from AY 1995–1996, during which no intraoperative anesthesia clinical pathway existed, served as historical controls. Data from AY 1996–1997, during which intraoperative anesthesia clinical pathways were used, served as the treatment group. Setting: Ambulatory surgery center in a teaching hospital. Measurements and Main Results: The records of 503 ASA physical status I and II patients were reviewed. 1996–1997 patients selected general anesthesia (±femoral nerve block) or epidural anesthesia, after which the remainder of the perioperative anesthesia process was standardized with respect to the drugs and equipment used. 1995–1996 patients did not necessarily have a choice in anesthesia technique and did not have a standardized perioperative anesthetic course with respect to specific drugs and supplies. Intervals described in the AACD Procedural Times Glossary, anesthesia drug and supply costs, and patient outcome variables (postoperative nursing interventions required and unexpected admissions), as influenced by anesthesia technique used, were measured. Combined general-regional anesthesia care for ACLR in 1996–1997, when compared with general anesthesia alone, led to increased pharmacy and materials costs and increased turnover time. However, patients with the combined technique showed improved recovery profiles and lower unexpected admission rates, and they required fewer nursing interventions for common postoperative symptoms. Patients receiving epidural anesthesia showed discharge outcomes similar to those patients receiving general anesthesia with femoral nerve block. Postanesthesia care unit bypass (fast-tracking) was more likely in clinical pathway regional anesthesia patients, when compared with the clinical pathway general anesthesia used. Conclusions: Clinical pathway regional anesthesia care for outpatient orthopedics may have a significant role in simultaneously containing costs and improving both process efficiency and patient outcomes.

Benchmarking the perioperative process: II. Introducing anesthesia clinical pathways to improve processes and outcomes and to reduce nursing labor intensity in ambulatory orthopedic surgery

Study Objectives: (1) To introduce anesthesia clinical pathways as a management tool to improve the quality of care; (2) to use the Procedural Times Glossary published by the Association of Anesthesia Clinical Directors (AACD) as a template for data collection and analysis; and (3) to determine the effects of anesthesia clinical pathways on surgical processes, outcomes, and costs in common ambulatory orthopedic surgery. Design: Hospital database and patient chart review of consecutive patients undergoing anterior cruciate ligament reconstruction (ACLR) during academic years (AY) 1995–1996 and 1996–1997. Patient data from AY 1995–1996, during which no intraoperative anesthesia clinical pathways existed, served as historical controls. Data from AY 1996–1997, during which intraoperative anesthesia clinical pathways were used, served as the treatment group. Regional anesthesia options were routinely offered to patients in the clinical pathway. Setting: Ambulatory surgery center in a teaching hospital. Measurements and Main Results: The records of 503 ASA physical status I and II patients were reviewed. 1996–1997 patients underwent clinical pathway anesthesia care in which the intraoperative and postoperative anesthesia process was standardized with respect to symptom management, drugs, and equipment used. 1995–1996 patients did not have a standardized intraoperative and postoperative anesthetic course with respect to the management of common symptoms or to specific drugs and supplies used. Intervals described in the AACD Procedural Times Glossary, anesthesia drug and supply costs, and patient outcome variables (postoperative nursing interventions required and unexpected admissions), as influenced by the use of the anesthesia clinical pathway, were measured. Clinical pathway anesthesia care for ACLR in 1996–1997, which actively incorporated regional anesthesia options, reduced pharmacy and materials cost variability; slightly increased turnover time; improved intraoperative anesthesia and surgical efficiency, recovery times, and unexpected admission rates; and decreased the number of required nursing interventions for common postoperative symptoms. Conclusions: Clinical pathway patient management systems in anesthesia care are likely to produce useful outcome data of current practice patterns when compared with historical controls. This management tool may be useful in simultaneously containing costs and improving process efficiency and patient outcomes.

Costing anaesthetic practice: reconciling perspectives and approaches

SummaryIn a previously published article by Broadway and Jones, the anaesthesia-related cost of a hernia repair operation was estimated to be £74.40, of which 21% was accounted for by anaesthetic agents and adjunct drugs. This result contrasts with our estimate of the total procedure cost for an inpatient hernia repair operation of £1,037.39, of which anaesthetic agents and adjunct drugs comprised less than 1%. In order to explain this difference, in this paper we compare and contrast our methodology for and perspective on costing resource use in anaesthesia with those used by Broadway et al. We conclude that these two apparently divergent results, once reconciled in terms of cost coverage and perspectives taken, are broadly equivalent (a reconciled cost of £78.21 compared with the £74.40 of Broadway and Jones.), and that the cost of anaesthetic agents and adjunct drugs constitute a small proportion of total procedure costs.

Evaluation of cost minimization strategies of anaesthetic drugs in a tertiary care hospital

A survey was undertaken to compare anaesthetic drug expenditures over a three-year period, to evaluate the impact of strategies offered to curtain continuously rising drug costs. Suggestions to control rising expenditures were based primarily on education of staff and residents regarding drug costs, emphasizing rational use of the more expensive drugs, and minimizing drug wastage. To assess the impact of these measures, a review of annual hospital budgets, global pharmacy expenditures, and anaesthetic drug expenditures was conducted for the period 1991 to 1993. Both absolute and proportional costs of anaesthetic drugs were compared, by year, according to six major classes: opioid analgesics (OA), muscle relaxants (MR), inhalational anaesthetic drugs (INH), intravenous anaesthetic drugs (i.v.), local anaesthetic drugs (LA) and a category labelled other drugs (OTH). In addition, the utilization patterns and unit price changes were compared for each drug for the periods 1991-92, and 1992-93. Total hospital drug costs increased from $7.1 M to $8.5M over the three years. During the same period, the cost of anaesthetic drugs decreased from $379K to $361K, despite an augmentation in annual case load from 12,507 to 13,076 surgical procedures. For the entire survey period, the mean cumulative anaesthetic drug cost was 4.6% of the pharmacy budget, or 0.24% of the hospital budget. Analysis by drug class revealed a $51K decrease in expenditures on OA. due to decreased utilization of fentanyl and alfentanil, and a decrease in the price of fentanyl. The increased expenditure on INH drugs was primarily due to an increase in acquisition costs.(ABSTRACT TRUNCATED AT 250 WORDS)

Anesthetic Drug Costs

Anesthetic Drug Costs

Practical methods of cost containment in anesthesia and surgery

With the increasing focus of national attention on health care and health care costs, anesthesiologists, along with all other medical specialists, must become more cost conscious in their practice behaviors. This review describes the current concerns about health care in the United States, including a discussion of some of the forces causing the increase in health care spending. The role of anesthesiology in the increase in health care costs is discussed. Practical methods for controlling anesthesia costs are outlined, including reducing preoperative testing, decreasing blood product use, and employing more regional and local anesthetic techniques. Several ideas for reducing the costs of anesthetic gases and drugs, including low-flow anesthesia and less expensive alternative drugs, are presented. The final section describes the changes in anesthesia drug use that occurred from 1992 to 1993 at one health care center (St. Francis Regional Medical Center, Wichita, KS, which is associated with the University of Kansas School of Medicine-Wichita). These changes resulted in a 13% reduction in anesthesia drug costs, which amounted to a savings of $127,472. The largest decreases were in anesthetic gases (16%), resulting from an increase in the use of low-flow techniques, and in muscle relaxants (26%), resulting from a switch to older lower-cost drugs.

Staff awareness of cost of anaesthetic drugs, fluids, and disposables.

Staff awareness of cost of anaesthetic drugs, fluids, and disposables.

Cost of anaesthetic drugs and clinical budgeting

Cost of anaesthetic drugs and clinical budgeting