[Costs of sevoflurane in the perioperative setting]

The total costs for a department of anaesthesia amount to a fraction of the total hospital budget that is proportional to the overall number of hospital departments; this means anaesthetic departments are in general not cost drivers. In the analysis of perioperative costs, anaesthesia accounts for about 10-15% of the total costs for the complete hospital stay, the exact proportion depending on the type of surgery. In the analysis of costs for the intraoperative period alone anaesthesia personnel contributes about 20%, and material costs about 10% of the total costs, while inhalational agents account for less than 1%. Aggregating the cost for inhalational agents, about 5% of the total budget of an anaesthesia department are accounted for by volatile agents, which take a 20% share of all drug costs in an anaesthesia department. When the costs of one MAC-hour of anaesthesia are compared, halothane, enflurane and isoflurane remain the cheapest agents. Sevoflurane is less expensive than desflurane at current market prices. However, at low fresh gas flows the price difference for one MAC-hour is marginal for these volatile anaesthetics. Total intravenous anaesthesia using propofol is even more expensive, more than 2- to 6-fold the costs of inhalational anaesthesia, depending on the dosage of the intravenous agent, the type of inhalational agent, the fresh gas flow, etc. In our hospital, overall costs for inhalational agents could be reduced over a three year period by increasing use of the low-flow technique, despite sevoflurane becoming the agent of choice for pediatric and ambulatory patients and for operations of short duration. An overall cost-effectiveness analysis must balance the costs of the various agents and the pharmacodynamic advantages of the new agents, e.g. rapid recovery from anaesthesia. Furthermore, indirect costs for side effects have to be taken into account, e.g., nausea and vomiting. The question of whether these effects and side effects translate into cost differences between agents depends largely on local factors, e.g., patient case mix, staffing, policy of discharge from the postanaesthetic care unit, and many others. We conclude that volatile anaesthetics account for only a minor portion of the budgets in the anaesthesia department and the hospital overall. The higher market price for the new agents that result in higher costs per MAC-hour may be compensated for by the economic impact of the fewer side effects and the shorter postanaesthesia stay in the hospital.