Calculation of comparative utilisation and cost: a South African perspective on intravenous vs. inhalational anaesthesia for procedures of differing duration

A randomised controlled trial comparing quality of recovery between desflurane and isoflurane inhalation anaesthesia in patients undergoing ophthalmological surgery at a tertiary hospital in South Africa (DIQoR trial)

Background

The patient's experience of their postoperative recovery is an important perioperative outcome, with the 15-item quality of recovery scale (QoR-15) recommended as a standardised outcomes measure. Desflurane has a faster emergence from anaesthesia compared with other volatile anaesthetics, but it is uncertain whether this translates to better subjective quality of recovery. The hypothesis for this study is that patients receiving desflurane for maintenance of anaesthesia would have better postoperative quality of recovery than patients receiving isoflurane.

Methods

Male and female adult patients undergoing ophthalmological surgery under general anaesthesia were randomly allocated to receive desflurane or isoflurane for maintenance of anaesthesia. The primary outcome was to compare postoperative QoR-15 scores. Secondary outcomes included comparing preoperative QoR-15 scores, volatile agent consumption, and time spent in the recovery room.

Results

Data from 164 patients were analysed (80 desflurane, 84 isoflurane). Median (Q1, Q3) postoperative QoR-15 scores were not significantly different (desflurane: 145 [141, 148], isoflurane: 144 [139, 147], 95% confidence interval 0-3, P=0.176, minimal clinically important difference=8). Median (Q1, Q3) volatile agent consumption was 15.4 (12.5, 19.3) ml hr-1 in the desflurane group, and 7.4 (5.9, 9.7) ml hr-1 in the isoflurane group. Median (Q1, Q3) time spent in the recovery room was significantly shorter in the desflurane group (desflurane: 18 [13, 23]; isoflurane: 25 [19, 32], 95% confidence interval -10 to 5, P<0.001).

Conclusions

This study found no difference in quality of recovery between patients who received desflurane or isoflurane for maintenance of general anaesthesia during ophthalmological surgery. A shorter time in the recovery room was not associated with improved QoR-15 scores.

Clinical trial registration

NCT04188314.

Cost-Effectiveness of Propofol (Diprivan) Versus Inhalational Anesthetics to Maintain General Anesthesia in Noncardiac Surgery in the United States

OBJECTIVES

It 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.

METHODS

Two 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.

RESULTS

Lower 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.

CONCLUSIONS

Maintenance 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.

Cost identification analysis of general anesthesia

BACKGROUND AND AIMS

Rising health costs are challenging anesthesiologists to search for cost-effective anesthetic techniques. We conducted a study to estimate variable cost per case and cost of drug wastage as percentage of total drug cost associated with different modalities of general anesthesia (GA).

MATERIAL AND METHODS

This prospective study was carried out after approval by institutional ethical committee in 258 adult patients aged 18-60 years of either sex, American Society of Anesthesiologists physical status I or II, with a surgical duration of 1-4 hours, posted for elective surgery under GA with endotracheal intubation. At the end of surgery, total utilization of each drug, anesthetic gases, and consumables were noted and remaining drug was regarded as wastage. Cost was recorded as per maximum retail price for that particular brand in the market at start of study and total cost was calculated. For purpose of analysis, cases were divided into low flow sevoflurane, high flow sevoflurane, high flow isoflurane, low flow isoflurane, and total intravenous anesthesia (TIVA).

RESULTS

The mean variable cost was highest with TIVA (₹2713.82 ± 509.57) and lowest with low flow isoflurane (₹1981.62 ± 335.03; P < 0.001). Drug wastage was 13.1% overall, with highest in low sevoflurane group and lowest in TIVA.

CONCLUSION

Low flow anesthesia with isoflurane is more cost-effective as compared to high flow techniques and TIVA even for short duration surgeries. Rational use of drugs and consumables and minimizing wastage can further reduce anesthesia costs.