Cost considerations in the use of anaesthetic drugs

Anaesthetic drugs typically comprise approximately 5% or less of a hospital pharmacy budget, yet they are a common target for cost reduction measures. In particular, there is considerable pressure to use less costly products where alternatives exist and to limit the introduction of expensive new ite ms. In considering strategies to reduce a departmental drug budget, or in defen ding against restrictions imposed from outside, it is: important to conside r all of the costs associated with anaesthetic drug delivery. These costs c omprise not only the expense of the anaesthetic drugs themselves, but also fixed and variable costs associated with their delivery and related to thei r effects. Elimination of drug waste will always be beneficial, since it ha s no direct effect on the patient yet clearly reduces cost. Waste is by no means confined to anaesthetic drugs, however. Using less expensive drugs ma y appear an attractive option and can reduce costs, provided that patient o utcome is in no way affected. Rarely is this the case. Once patient care is modified, through changes in recovery times or complic ation rates, determining the true cost of the intervention becomes essentia l; there may be increases in indirect costs which dwarf the apparent saving s. Sometimes indirect costs will rise by a lesser amount than savings in di rect costs, such that there is still an overall benefit but less than that originally anticipated. Exactly how indirect effects result in indirect cos ts is highly variable. The requirement for additional drugs or supplies to treat an adverse event, such as emesis, will always have an associated cost . Delayed recovery or prolonged hospital stay will waste operating room tim e or increase the amount of time that a patient requires nursing care, but whether this carries an associated cost depends on what the staff would oth erwise have been doing. Depending on the employment method, staff may have been sent home early (with less pay) or employed at identical cost but with less to do. Many studies which purport to consider all costs either ignore such issues, or make invalid assumptions. These issues are complex, but an yone involved with decisions concerning anaesthetic costs should be familia r with the underlying principles and be able to make a rational assessment of the likely indirect costs in their own institution.