New drugs in anaesthesia: can we afford them?

The most important challenge facing physicians today is the dilemma of providing high quality care in a fiscally responsible fashion. Cost can no longer be ignored. Pharmacoeconomics is a fundamental component of medical education. Economic issues should be an integral part of the drug development and clinical trials. While anaesthetists are concerned that the use of less expensive drugs may compromise patient outcome and satisfaction there is little evidence to support such concerns. This is a fertile area for intense future research. Pharmacoeconomics is a dynamic. The cost of drugs is not static, patterns of drug use shift rapidly and clinical practice is in a state of constant change. The answer to cost containment is not simply to cut, cap, delist or merely hope for the best, but rather to manage and modify practice while accommodating changing needs. Educational programmes, guidelines, department policies, system changes and financial incentives can be implemented to ensure consistent and enduring adherence to the principles of pharmacoeconomics and value based care. Some suggest that national societies should create guidelines for cost-beneficial practice. Others favour physician autonomy in drug selection. Changing physician behaviour is difficult. This change will occur gradually and will be the topic of many emotionally charged philosophical debates. There will be great reluctance to deny patients pharmacologically superior drugs based on cost alone, especially since drugs are such a small portion of the total costs. We must exercise caution to ensure that we don't become penny wise and pound foolish. Drug acquisition costs are only one element in a large and complex equation. Concentrating on acquisition drug cost may be dangerous, even naive if we fall prey to knowing the cost of everything but the value of nothing.