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The cost effectiveness of anesthesia workforce models: a simulation approach using decision-analysis modeling
1University of Rochester School of Medicine, Rochester, New York 14642, USA.
Anesthesia and Analgesia
|March 7, 2000
Summary
Physician-only anesthesia is not cost-effective. An anesthesia care team with a physician to certified registered nurse anesthetist (CRNA) ratio of 1:8 is cost-effective for low-risk patients, offering a better value than nurse-intensive models.
Area of Science:
- Health Economics
- Anesthesiology
- Healthcare Management
Background:
- Anesthesia workforce staffing significantly impacts healthcare costs and patient outcomes.
- Optimizing the skill mix of physicians and certified registered nurse anesthetists (CRNAs) is crucial for efficient anesthesia delivery.
- Previous studies have explored various staffing models, but cost-effectiveness analyses of different physician-to-CRNA ratios are essential.
Purpose of the Study:
- To evaluate the incremental cost-effectiveness of different anesthesia workforce staffing scenarios.
- To compare various skill mixes, including physician-intensive and nurse-intensive models, using decision analysis.
- To identify the most cost-effective anesthesia care delivery system from a payer's perspective.
Main Methods:
- A decision tree model was constructed to analyze five distinct anesthesia staffing scenarios.
- Scenarios ranged from physician-only to nurse-intensive models, incorporating varying physician-to-CRNA ratios.
- Cost-effectiveness was assessed by comparing incremental costs and outcomes across different staffing configurations.
Main Results:
- Physician-only anesthesia staffing was found to be not cost-effective.
- The "third-team" model, featuring a physician to CRNA ratio of 1:8 for low-risk patients, demonstrated cost-effectiveness compared to nurse-intensive models.
- A physician to CRNA ratio of 1:2 was identified as the preferred staffing scenario for intermediate-risk patients.
Conclusions:
- The "third-team" anesthesia staffing model offers a cost-effective approach, particularly for low-risk patient populations.
- While medical direction of CRNAs for low-risk patients is cost-effective, increasing the physician to CRNA ratio beyond 1:8 may not provide justifiable incremental benefits.
- Anesthesia care-team approaches, with optimized physician-to-CRNA ratios, represent a more cost-effective strategy than physician-only or purely nurse-intensive models.
