Introduction

Recent reviews and editorials emphasise the importance of cost effectiveness assessment in anaesthesia.^1,2 Accurate cost estimation is mandatory for rigorous cost effectiveness studies. The aim of this study was to obtain patient-specific anaesthesia costs, to facilitate a future economic evaluation.

Method

A prospective observational study was carried out in a non-teaching hospital in the North-West region. Adults undergoing elective inpatient orthopaedic surgery were included. Patients were identified from theatre lists and their verbal consent obtained before proceeding with data collection, in line with Local Research Ethics Committee conditions.

The three main areas of data collected were variable costs [drugs and disposables], semi-fixed costs [staff costs], and fixed costs [equipment and overheads]. Data collection started when the patient entered the anaesthetic room and continued until discharge. Variable costs were attached according to the unit cost and quantity used. Semifixed costs were attached according to the time spent by the anaesthetic, medical and nursing staff caring for the patient. Anaesthetic equipment and overhead costs were apportioned by perioperative time (cost/hour). Costing was performed from the perspective of the Trust. The study period extended from April 2000 to July 2001 following a two-week pilot study. Unit costs were for the year 2000.

Results

Data were collected on a total of 95 patients [Female="44", mean age (SD)= 60.7(15.6)]. Forty four patients received general anaesthetic techniques, forty eight received general anaesthesia plus regional techniques [spinal, epidural, or peripheral nerve block], and three received regional techniques supplemented by sedation.

The mean total anaesthesia related costs was £369.3 [SD: £90.7, median: £349.41,IQR: £317.2-418.3]. The breakdown of cost is shown in Table1.

Table 1. Anaesthesia cost components

*IQR: 25-75% interquartile range

The drugs and disposable cost was significantly higher in patients receiving combination of general and regional anaesthetic techniques compared to those receiving general anaesthesia only [mean (SD): £40.2 (2.7) versus £ 29.2(2.1) respectively; P<0.001].

Discussion

Drug costs accounted for a small part of the total cost of anaesthesia. The detailed cost analysis resulted in the identification of differences in cost between anaesthetic techniques. The results of this study will be used in a future economic evaluation of the use of regional anaesthesia in orthopaedic surgery.

References

1. Fisher DM, Macario A. Economics of anesthesia care: a call for arms. [editorial] Anesthesiology 1997;86:1018-9.
2. Rowe WL. Economics and anaesthesia. Anaesthesia 1998;53:782-788.