INFLUENCE OF COST EFFECTIVENESS STUDY OF ANAESTHESIA (CESA) ON ANAESTHETISTS’ PRACTICES AND OPINIONS

J Kerr, J Bennett, JK Moore, EW Moore, RA Elliott on behalf of the CESA team.

Wirral Hospitals NHS trust, Wirral, Cheshire, CH49 5PE

Introduction

The choice of anaesthetic agent and technique may affect perioperative well being [1]. Experience and personal preference may influence the choice of the anaesthetist, who may resist change [2]. The aim of this survey was to investigate the influence of performing a clinical trial on the opinions and practices of experienced anaesthetists. The CESA trial investigated the relative costs, patient benefits and acceptability of anaesthetic agents in day-case surgery [3], comparing target-controlled infusion (TCI) with intravenous induction/ volatile maintenance and total inhalational anaesthesia.

Methods

Anaesthetists (n=26) who had taken part in CESA were interviewed about their usual clinical practice and their opinions of the CESA treatment arms, prior to the CESA results being analysed.

Results

Table 1. Anaesthetists’ opinions of the qualities of each CESA randomisation group.

	Considered to be	Patient acceptance	Cost-effectiveness	Avoidance of nausea/vomiting	Ease of use	Avoidance of adverse events on induction	Overall favourite
Propofol TCI	overall best: overall worst:	77% 0%	0% 58%	100% 0%	4% 65%	50% 19%	31% 31%
Propofol/ isoflurane	overall best: overall worst:	54% 8%	85% 4%	23% 4%	81% 0%	46% 4%	65% 4%
Propofol/ sevoflurane	overall best: overall worst:	50% 0%	0% 12%	23% 0%	50% 0%	58% 0%	12% 0%
Sevoflurane/ sevoflurane	overall best: overall worst:	4% 81%	12% 20%	23% 65%	12% 31%	19% 65%	0% 62%

85% of our interview sample usually gave a propofol induction with isoflurane maintenance as their standard technique for day cases. Four (15%) stated that since the start of CESA, they had changed their technique to a TCI.

54% stated that they would consider changing their usual technique, if CESA demonstrated significant differences in the incidence of post-operative nausea and vomiting between groups. 58% would not change technique if differences in cost-effectiveness were shown.

References

1. Tang J, Chen L, White PF et al. Anesthesiology 1999; 91: 253-61

2. Smith J. BMJ 2001; 322: 1257-8

3. Elliott RA, Moore JK, Davies L et al "Which Anaesthetic Agents and Techniques are Most Cost Effective in Day Surgery?" HTA report 2001 (submitted)

CESA was funded by the National Centre for Health Technology Assessment (UK).

Page last revised: August 07, 2008.

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