[Economic aspects of anesthesia. II. Cost control in clinical anesthesia]

The primary scope of economic analyses is the quantification of the costs (input) in relation to the results (outcome, output). According to whether a similar or different dimension of outcome parameters is chosen, it is possible to differentiate between cost minimisation, cost effectiveness, cost benefit and cost utility analyses. Decision trees and sensitivity analyses serve to develop or examine cost outcome studies. The principal perspective of economic analysis is of crucial significance. In the present overview of cost control programmes in clinical anaesthesia, the perspective chosen throughout is that of budget responsibility in a department of anaesthesiology. With regard to economic factors in clinical anaesthesiology, the cost of medical and nursing staff represents the largest cost block. It is, therefore, essential that personnel is efficiently employed, i.e. how the perioperative procedure is organised. In the area of material costs, blood products--including coagulation factors and plasma substitutes--are particularly cost intensive, followed by medical products and drugs, especially muscle relaxants and inhalational anaesthetics. In the perioperative context, the costs of anaesthesia personnel account for 5-15% of the total costs of patient care, while material costs account for 2-10%. In view of this small portion of the total costs, cost control programmes in anaesthesia can only make a relatively small contribution to reducing overall cost. However, it must be realised that anaesthesia care is vitally important for the perioperative process which means that in this context cost-effectiveness interventions have consequences that also affect other fields, e.g. postoperative pain service besides anaesthesia. In conducting economic analyses, cost considerations or reductions cannot be targeted alone, but must always also integrate outcome aspects so that costs and quality are regarded in relation to one another.