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

Abstract

Objectives: The cost of various anaesthetic techniques fluctuates and is seldom transparent, because of complicated anaesthetic protocols. The theoretical costs of different anaesthetic techniques were compared in this study. Design: This comparative study utilised protocols that determined the cost of inhalational anaesthesia, based on evidence from relevant literature. Propofol target-controlled infusion (TCI) was used as the intravenous protocol [Alaris^® PK syringe pump (Schnider model), Cardinal Health, UK]. Setting and subjects: No patients were involved in this theoretical cost analysis. Outcome measures: The calculated costs of high- vs. low-flow inhalational anaesthesia and inhalation vs. intravenous anaesthesia with propofol, with or without N₂O, and procedures of a longer and shorter duration were compared. Results: Trends were noted. High-flow inhalational anaesthesia tended to be more expensive than low-flow inhalational anaesthesia. The savings that were gained by implementing low-flow anaesthesia increased with the duration of procedure. The savings were greater when less soluble inhaled anaesthetics were used. Isoflurane and halothane anaesthesia cost more when N₂O was added. Inhalational anaesthesia with isoflurane was the most cost-effective option consistently. Anaesthesia with desflurane was always the most expensive option. Propofol TCI was less expensive than sevoflurane for long procedures. Conclusion: Anaesthetic drugs account for only 3-4% of the total cost of a surgical procedure, but economic use thereof frees up resources for other essentials in financially challenging times. Isoflurane should be used widely. N₂O should probably be used conservatively as it increases the anaesthetic cost and contributes to pollution and ozone depletion. Propofol TCI can be considered instead of sevoflurane inhalational anaesthesia for longer procedures.