Part II: total episode costs in a randomized, controlled trial of the effectiveness of four anesthetics.

UNLABELLED: Newer anesthetics promise improved clinical outcomes, but usually come at a higher price per dose. Previous studies have found few economic benefits in the immediate postoperative period, but have hypothesized that earlier recovery may lead to lower costs for the whole episode of hospitalization. This study uses cost data for patients enrolled in a randomized, controlled clinical trial comparing four anesthetics to test whether the higher costs of the newer anesthetics would be offset against decreased use of other hospital resources. Five hundred general surgery patients were randomly assigned to one of four anesthetic regimens. Estimates from the hospital's patient costing system were used, with validated cost records for a subset of 360 patients. Five patients admitted to the intensive care unit or requiring prolonged hospitalization skewed the distribution of costs, but none of these complications could be attributed to anesthesia. No significant differences were found on length of stay, mean episode cost, operating room costs, ward costs, or readmission rate within 3 mo. The study was not powered to sufficiently show differences in intensive care unit admission or other uncommon outcomes. Patient quality of recovery did not vary among groups, but neither patient willingness-to-pay nor satisfaction were directly measured.

IMPLICATIONS: Propofol and sevoflurane do not offer any significant economic advantages over thiopental and isoflurane in adults undergoing elective inpatient surgery.