Sources of Variation in Anesthetic Drug Costs

Area of Science:

• Health Economics
• Anesthesiology
• Healthcare Management

Background:

• Healthcare expenditures, particularly anesthetic-related drug costs, are under increasing scrutiny.
• Identifying key drivers of variation in anesthetic drug spending is crucial for cost management.

Purpose of the Study:

• To identify significant contributors to anesthetic drug cost variation across different surgical procedures and institutions.
• To analyze the impact of attending anesthesiologist, case type, and procedure duration on drug costs.

Main Methods:

• Utilized anesthesia information management systems to collect volatile and intravenous drug costs for 8 inpatient surgical procedure types.
• Employed fixed-effects linear regression models with logarithmically transformed case cost as the outcome variable.
• Analyzed patient demographics, American Society of Anesthesiologists (ASA) physical status, case duration, provider, and institution as independent variables.

Main Results:

• The median anesthetic drug cost was $38.45, with models explaining 32.3%–35.2% of cost variation.
• Attending anesthesiologist, case type, and procedure duration were identified as the largest sources of cost variation.
• Average cost differences between attending anesthesiologists ranged from -$41.25 to +$95.67; institutional differences were minor ($5.73).

Conclusions:

• A significant portion of anesthetic drug cost variation remains unexplained, suggesting high per-case random variation.
• While attending anesthesiologist, procedure type, and case duration are key cost drivers, the overall anesthetic drug cost is relatively small.
• Cost-saving interventions focused on attending anesthesiologist practices may yield negligible savings; efforts might be better directed elsewhere.