The economics of newer anaesthetic drugs: should we take the Rolls‐Royce or the bicycle today?

benefit analysis, and in units of success or effect New anaesthetic drugs and techniques characterized (e.g., costs per patient free from postoperative nausea by a faster onset and a more rapid recovery have and vomiting) in cost-effectiveness analysis. The been introduced into clinical practice during the last uncertainties in the assignment of monetary values decade. These advances have permitted a greater to the benefits makes cost-benefit analysis more ease of titratability of anaesthetic depth, but cost difficult to perform than cost-effectiveness analysis. more than the older drugs and techniques they were A more expensive drug may still be more costdesigned to replace. Thoughtful physicians have effective if associated with an improved outcome always been aware that they cannot practice medicine that decreases the overall unit cost (2). Cost-utility in isolation from the society they and their patients analysis is a variant of cost-effectiveness analysis but live in, and so have balanced medical practices uses a unit of a patient-assessed quality of life as the with economics to provide affordable quality outcome measure (3). care. Pharmacoeconomics, the formal study of the The methods used to assess the costs of a medical relationship of costs of drug therapy to health intervention are the same for all four techniques of care systems, is a more recent development with economic evaluation, and include direct and indirect its own terminology and jargon. This field of costs. Direct costs may be fixed, which do not change pharmacotherapeutics is increasingly important with the number of patients treated (e.g. maintenance to our specialty as anaesthetic drug costs are costs of the physical structure), or variable which are highly visible and easy targets for scrutiny by related to the number of patients treated (e.g., costs administrators, even though they constitute less than for drugs used for induction of anaesthesia). The 6% of total perioperative costs (1). In this editorial, direct costs of a therapeutic regimen are not limited we will discuss the methods for assessing the financial to the acquisition cost of the amount administered, impact of newer drugs and techniques and the but include costs of wasted drug, equipment for importance of examining the total costs of a its administration (e.g. infusion pumps, intravenous therapeutic strategy rather than concentrating on sets), pharmacy labour costs, and the costs of only drug acquisition costs. managing drug-induced side effects. These costs will Four measures are commonly used in economic vary according to the perspective of the person assessments: (i) cost-minimization, (ii) cost-benefit, making the evaluation and the health care payment (iii) cost-effectiveness, and (iv) cost-utility analyses system prevalent in the country (4,5). The common (2,3). Cost-minimization is a simplistic comparison perspectives used in health care cost analyses include of the acquisition costs of alternative drug therapies (i) society as a whole, (ii) health insurance companies without taking patient outcome into consideration. or other payers, (iii) health providers, and (iv) the In contrast, patient outcomes are included in the patient. What appears relevant from one perspectcomputation of the other three methods (cost-benefit, ive may not hold true from another. For instance, cost-effectiveness and cost-utility analyses). The costs of a disease process from a patient’s viewpoint