Cost benefit analysis of nitrous oxide in major surgery
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Cost-benefit analysis of nitrous oxide in major surgery. Presenter: Dr Alison Graham 2 nd year Anaesthesia Advanced Trainee Co-Authors: Prof Paul S. Myles, Prof. Kate Leslie, Prof. Matthew T.V. Chan, Prof. Michael J. Paech, Dr Philip Peyton and Prof. Abdelazeem A. El. Dawlatly.

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Cost-benefit analysis of nitrous oxide in major surgery

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Cost-benefit analysis of nitrous oxide in major surgery

Presenter: Dr Alison Graham

2nd year Anaesthesia Advanced Trainee

Co-Authors: Prof Paul S. Myles, Prof. Kate Leslie,

Prof. Matthew T.V. Chan, Prof. Michael J. Paech,

Dr Philip Peyton and Prof. Abdelazeem A. El. Dawlatly


Topics:

  • Review ENIGMA trial

  • Cost-benefit analysis

    • Methods

    • Results

    • Limitations

    • Conclusion


ENIGMA Trial

  • The Avoidance of Nitrous Oxide in Major Surgery

  • What are the consequences of using nitrous oxide?

80% O2 & 20% N2

  • 30% O2 & 70% N2O

VS


ENIGMA Results


ENIGMA Trial Results

Kaplan-Meier estimates of discharge from the intensive care unit


ENIGMA Results


ENIGMA Results


Criticism of the ENIGMA Trial

  • “Despite the concerns regarding its adverse effects, nitrous oxide has actually had a central position in anesthetic practice primarily becauseit is inexpensive, widely available, and has a long-standing safety profile. The most obvious advantage of using nitrous oxide is that it allows a dose reduction of other anesthetic agents and opioids, which translates into less cardiovascular depression and significant cost reduction”

    Anesthesiology 2008; 108:541-2


Cost-Benefit Analysis of the ENIGMA Trial

  • What is the financial cost of using nitrous oxide?


Health economics


Health economics

Health economics

Cost Minimisation

Cost benefit - $ only

Cost effectiveness – natural units

Cost utility - QALY


Cost-Benefit Analysis of the ENIGMA Trial

  • What is the financial cost of using nitrous oxide?

  • From the hospital administration’s point of view


Costs saved

Maintenance anaesthetic

Analgesia

Vasopressors

Expenses

PONV prophylaxis

PONV

Infection/fever

Pneumonia

Atelectasis

PACU

ICU

HLOS

Cost-benefit N2O: variable costs


Costs saved

Maintenance anaesthetic

Analgesia

Vasopressors

Expenses

PONV prophylaxis

PONV

Infection/fever

Pneumonia

Atelectasis

PACU

ICU

HLOS

Cost-benefit N2O: variable costs


Contributing Cost Estimates


Contributing Cost Estimates


ENIGMA Cost-Benefit Analysis: Results

Estimated costs per patient (US dollars), Mean ± SD


ENIGMA Cost-Benefit Analysis: Sensitivity Analysis

Estimated costs per patient (US dollars), Mean ± SD


Cost-Benefit Analysis Limitations

  • Estimated costs (but the statistics are real)

  • Hospital perspective only

  • Use of published estimates of costs

    • Precedent studies mostly from developed countries

    • No discrimination on methods

  • Variable costs only included

  • PACU costs controversial


Conclusions

  • There are significant additional costs with N2O use

  • No compelling argument to use N2O on the basis that it is an inexpensive drug


Questions


Sensitivity Analysis


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