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| The UK Society for Intravenous Anaesthesia |
| Based in the UK - as a resource for Anaesthesia Worldwide |
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Annual Scientific Meeting, Belfast; November 2000. Anaesthetic drug costs in a district general hospital day surgery unit M Stocker, K HoughtonDepartment of Anaesthesia, South Devon Healthcare Trust Recent advances within anaesthesia have included the introduction of propofol infusions for the induction and maintenance of anaesthesia and remifentanil infusions for intra-operative analgesia. These agents are associated with a low incidence of nausea and vomiting, rapid emergence from anaesthesia and hence shorter stay in the recovery ward, earlier discharge from day-area units and decreased admission rates1,2,3. However in many units the cost of these drugs is thought to be prohibitive and hence limits their use. We have analysed the drug costs within the Day Surgery Unit of a District General Hospital over a 4 year period in order to quantify the cost of the increased use of these drugs. The unit is self contained, treats no inpatients and is able to identify its own expenditure and workload. A list of the top hundred drugs used in the unit within a 4 year time period (1996-2000) was obtained from the hospital pharmacy department. Any drugs not used by anaesthetists were excluded. The cost of each drug for each year being studied was recorded. Information about total numbers of cases done in this time period, length of cases, how many were under general anaesthesia and of these what percentage were anaesthetised using total intravenous anaesthesia was also retrieved from the unit database. We were not able to obtain costs for anaesthetic consumables. Within the time period studied total theatre activity in terms of cases performed increased by 22.7%. However, cases performed using TIVA increased by 25%. This was associated with an increased cost of anaesthetic drugs per general anaesthesia case, but this was only an increase of 17.8%. It will be noted that during this time period the time per case has increased. This is due to a change in the case mix within the day surgery unit resulting in longer cases being performed here. When account is taken of procedure time within our calculations it can be seen that the cost of anaesthetic drugs measured per hour of theatre time has actually reduced over this period.
We have shown that the increasing use of agents often classed as expensive, has not resulted in increased anaesthetic drug costs when measured per hour of general anaesthesia. These drugs constitute a small percentage of the total cost of a day surgery procedure within our unit. It would therefore appear that the most effective way to reduce the actual cost per case would be to achieve more cases with the same overhead and staff costs. Using drugs which aid faster, complication free recovery may contribute to an increased throughput of cases. We would therefore advocate the continued use and development of these techniques which have been shown to have many advantages both to the patients and to the smooth and efficient running of theatre units.
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