COST-EFFECTIVENESS OF MODERN INHALATIONAL ANESTHETICS USING SEVOFLURANE AS AN EXAMPLE

The economic impact of the new German health care laws requires an awa reness of cost-effectiveness when using newer drugs. The main goal in patient care, i.e., effective treatment, must be achieved by the ratio nal use of restricted resources at a maximum degree of effectiveness. Economic aspects of the new inhalational anaesthetics such as sevoflur ane are discussed in this article. The cost of inhalational anaestheti c agents accounts for up to 5% of all the running expenses of an anaes thesia department. The consumption and cost of an inhalational agent d epend on fresh gas flow,vapour setting, and duration of anaesthesia. C omparing the cost for 1 MAC-h of anaesthesia, desflurane is more expen sive at current market prices than sevoflurane and isoflurane. However , at low or minimal fresh-gas flows, the price for one MAC-h is almost the same for these volatile anaesthetics. Total intravenous anaesthes ia using propofol is even more expensive, partly due to wastage, i.e., opened ampoules with a remainder of propofol that has to be discarded after each case. When choosing an anaesthetic agent, the price of 1 m l liquid anaesthetic is an important factor. However, the overall cost -effectiveness analysis must balance the cost of the agent with its ph armacodynamic advantages such as more rapid recovery from anaesthesia. Furthermore,the indirect costs of side effects have to be taken into account. For example, nausea and vomiting lead to a prolonged stay in the recovery room after anaesthesia for outpatient surgery, which in t urn incurs additional casts for antiemetic drugs and the extra time fo r nursing care. Therefore, a lower incidence of nausea and vomiting an d a more rapid recovery from anaesthesia leading to earlier discharge from the recovery room may compensate for the higher price. Volatile a gents account for up to 1% of the total intraoperative costs. In analy sing the costs of 1 h of anaesthesia, other products such as plasma su bstitutes and blood products account for a much higher proportion than anaesthetic agents, and reductions or increases in costs pertaining t o these products have a bigger impact on overall costs than do volatil e anaesthetics. We conclude that volatile anaesthetics account for onl y a minor portion of the anaesthesia department budget and the cost of anaesthesia delivery. The higher market price of the new agents may b e compensated for by the economic impact of fewer side effects and a s horter post-anaesthesia stay in the hospital. In analysing data for se voflurane, this agent may be cost-effective, for example, for outpatie nt anaesthesia.