Anaesthetic drug costs are not increased by propofol

Anaesthesia drug cost, control and utilization in Canada

PURPOSE

To investigate the attitudes of senior anaesthetists toward issues of anaesthesia drug cost control, utilization, and education, and to determine patterns of drug use of common clinical scenarios.

METHODS

A questionnaire mailed to heads of anaesthesia departments in all large (> 200 beds) Canadian hospitals (n = 187). Data were analyzed with chi-square and t tests; P < 0.05 was considered significant.

RESULTS

Sixty-eight per cent responded to the questionnaire. Ninety-four per cent considered cost when choosing anaesthetic agents, 63.7% indicated cheaper drugs could be used without decreasing quality of care, and 46.3% that restricted access to expensive agents was justified. Only 32.8% of hospitals currently imposed restrictions. Departmental practice guidelines were favoured by 82.1% of respondents. Fifty-three per cent considered resident education about drug cost to be inadequate, and 57.4% indicated that resident teaching justified the use of expensive agents. Most respondents (69.8-96.8%) felt they knew the cost of commonly used agents, many made considerable use of cheaper agents such as halothane, curare and morphine, and 61% re-used syringes containing residual drug. A few differences between teaching and non-teaching hospitals anaesthetists were identified.

CONCLUSIONS

These anaesthetists demonstrated awareness of pharmacoeconomic issues, believed that cheaper anaesthetic agents could be used without compromising quality of care, identified few hospitals with policies that restricted drug use, and indicated drug cost education could be improved. Control and responsibility of drug utilization were shared within their hospitals. Many approved the idea of practice guidelines. In common clinical scenarios cheaper agents were preferred and syringe re-use was surprisingly common.

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)