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Pharmacoeconomics of Inhaled Anesthetic Agents: Considerations for the Pharmacist
American Journal of Health-System Pharmacy
Pharmacoeconomics of Inhaled Anesthetic
Agents: Considerations for the Pharmacist
Eric L. Chernin
Abstract and Introduction
Types of economic analyses used for inhaled anesthetic agents, factors to consider in
calculating the cost of inhaled anesthetics, limitations of pharmacoeconomic studies of these agents, and
strategies for controlling inhaled anesthetic costs are discussed.
Inhaled anesthetic agents comprise a substantial component of drug budgets. Calculation of
the cost of administering an inhaled anesthetic should take into consideration the cost per mL, potency,
waste, concentration and duration of gas delivery, fresh gas flow rate, molecular weight, and density. The
use of newer inhaled anesthetic agents with low solubility in blood and tissue provides a more rapid
recovery from anesthesia than older, more soluble agents, and also provides the same level of control of
depth of anesthesia at a lower fresh gas flow rate and possibly a lower cost than older agents at a higher
fresh gas flow rate. A more rapid recovery may facilitate fast-track recovery and yield cost savings if it
allows the completion of additional surgical cases or allows a reduction in personnel overtime expenses.
Interpretation of pharmacoeconomic studies of inhaled anesthetics requires an appreciation of the
limitations in methodology and ability to extrapolate results from one setting to another. Pharmacists'
efforts to reduce anesthetic waste and collaborate with anesthesiologists to improve the use of these
agents can help contain costs, but improving scheduling and efficiency in the operating room has a
greater potential to reduce operating room costs.
Much can be done to control costs of anesthetic agents without compromising availability of
these agents and patient care.
Acquisition costs for all medications have risen dramatically in recent years, outpacing inflation in general,
a trend that is likely to continue. Unfortunately, private and governmental reimbursement rates have not
kept pace. Hospital administrators tend to focus on readily identifiable causes of increases in drug
and require pharmacy departments to justify the purchase of costly new drugs. Medications
used in anesthesia may comprise a substantial portion of pharmacy drug budgets in hospitals with large
surgery programs. Anesthesia drugs account for 10-13% of the drug budget at Sarasota Memorial
Hospital. Unfortunately, drug costs often are viewed by administrators in a compartmentalized manner,
according to the budgets of individual departments, rather than from a broader institutional perspective
that takes into consideration costs (or savings) associated with drug use, and patient outcomes, beyond
those associated with acquisition costs (e.g., costs of nursing staff time, adverse effects, time to