Patterns of volatile anesthetic utilization among anesthesiologists in a tertiary teaching hospital: the need for a pharmacoeconomic "Wake-up" policy for the "Sleep Agents"

ABSTRACT

The goal of cost-containment in anesthesia requires a global, multif actorial approach. Practice patterns need to be optimized by determined leadership, motivation and commitment of all concerned. It is clear from the current national debate on health care priorities that every health care worker, the anesthesiologist included, needs to examine not only the economic consequences of his daily practice decisions, but also his daily practice patterns of behavior in the operating room. When the patient grants his consent for anesthesia, he puts his complete trust on the anesthesiologist and then goes to sleep. He trusts that the anesthesiologist will give him the best anesthetic, and implicitly, that he [the anesthesiologist) would safeguard his interest and minimize cost. Objectives: 1) To determine the current patterns of volatile anesthetic utilization among the anesthesiologists in our institution; 2) To make a cost-minimization analysis of these practice patterns; and, 3) To collect baseline data prior to the development of pharmaceutical practice guidelines in anesthesiology for our institution. Materials and Methods: A cross-sectional survey was done using the anesthesia records of all patients admitted into the operating room at the Private Division of the University of Santo Tomas Hospital for the month of February 2000. The patients were stratified into those receiving general anesthesia and those receiving regional anesthesia. Only those surgical cases that required general inhalation anesthetic whether as primary or supplemental agent where included in the evaluation. The most commonly used volatile inhalation agents were determined. The cost of delivering inhalation anesthesia either as a single agent or in combination with a regional technique is determined by surveying the charges made for each individual case. Results: Total charges for anesthetic drugs used, including oxygen and local anesthetic agents amounted to Php 1,055,401.60. Charges for drugs alone amounted to Php 1,027,436.60, of which Php 42,738.00 comprise the cost of local anesthetics for regional techniques. All other drugs used amounted to PhP 984,698.60. The total cost for volatile inhalation agents alone comprised 47.9 percent of which sevoflurane accounted for the highest share of Php 378,425.45; isoflurane, Php 26,650.00; enflurane Php 14,908.00 and halothane Php 600.00. The neuromuscular blockers accounted for 16.5 percent; the sedative-hypnotics, diprivan (2.2 percent) and midazolam (2.5 percent); and the opiate agonist, fentanyl (1.9 percent) and partial agonist nalbuphine (3.3 percent) comprise a great part of the rest of the charges. Discussion: Pharmacoeconomics is an increasingly important consideration in the adoption of new drugs into practice. Not only must a new drug confer greater therapeutic benefit, but also that benefit must not be bought at too high a price. For injected drugs, determination of relative cost is straightforward. This is not true for inhaled anesthetics because cost is related to more than the amount of drug taken up; cost is also determined by waste of anesthetic consequent to delivery of anesthetic in excess of the amount taken up. It is not surprising therefore, that the charges for the volatile anesthetics are very much higher than the expected cost of consumption, practically accounting for 60-75 percent of charges for all anesthetic drugs combined. It behooves every anesthesiologist therefore to consider the cost of their pharmaceutical choices at all times and undertake cost minimization strategies for drugs used in anesthesia, especially the volatile anesthetics. (Author)