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Association between the EU desflurane phase-out and secondary market vaporizer prices: An observational time-series
Onishi Tatsuki1, Tatsuyoshi Ikenoue1,2
1Data Science and AI Innovation Research Promotion Center, Shiga University, Shiga 522-8522, Japan.
Background:
The European Union restricted desflurane-the volatile anesthetic with the highest commonly reported 100-year global warming potential (GWP100 ≈ 2540 CO₂ equivalents)-for routine use from 1 January 2026 under Regulation (EU) 2024/573, with exemptions for clinically necessary cases. Whether this targeted environmental regulation was associated with collateral economic effects on non-targeted anesthetic equipment markets has not been examined. We investigated whether the EU desflurane regulation was associated with changes in secondary market prices of anesthetic vaporizers, and whether any such changes were agent-specific or extended to non-regulated agents (sevoflurane, isoflurane).
Methods:
We conducted a cross-sectional time-series analysis of completed eBay sales of desflurane, sevoflurane, and isoflurane vaporizers over three years (March 2023 to March 2026), spanning the full EU regulatory timeline. Temporal trends were assessed using Spearman rank correlation and Kendall τ across ordered regulatory phases. Pre-/post-ban comparison used the Mann-Whitney U test with Cohen's d effect size. Sensitivity analyses included bootstrap resampling (10,000 iterations), post-hoc power simulation under observed lognormal parameters, and a comparative interrupted time-series (CITS) model of monthly median prices with sevoflurane and isoflurane as controls.
Results:
1033 completed sales were analyzed (158 desflurane, 321 sevoflurane, 554 isoflurane). Desflurane vaporizer prices declined (Spearman ρ = -0.28, P < 0.001; Kendall τ = -0.12, P = 0.049), with a 31% decline pre- to post-restriction (Cohen's d = -0.47). Sevoflurane showed no trend. Isoflurane reached nominal significance in Spearman (ρ = -0.09, P = 0.044) and Kendall τ (τ = -0.07, P = 0.025) tests, but the quarterly median trend was not significant; these isolated P values, with small effect sizes, are interpreted cautiously.
Conclusions:
Desflurane vaporizer prices on eBay were associated with an agent-specific decline; non-regulated agents remained comparatively stable. These observational findings are consistent with, but do not establish, an effect of the EU desflurane phase-out and should be interpreted as hypothesis-generating, given the single-platform design, unmeasured confounders, small post-restriction sample size, and multiple trend tests.
