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

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

Topics:

  • Review ENIGMA trial

  • Cost-benefit analysis

    • Methods

    • Results

    • Limitations

    • Conclusion


Enigma trial

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 Results


Enigma trial results

ENIGMA Trial Results

Kaplan-Meier estimates of discharge from the intensive care unit


Enigma results1

ENIGMA Results


Enigma results2

ENIGMA Results


Criticism of the enigma trial

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

Cost-Benefit Analysis of the ENIGMA Trial

  • What is the financial cost of using nitrous oxide?


Health economics

Health economics


Health economics1

Health economics

Health economics

Cost Minimisation

Cost benefit - $ only

Cost effectiveness – natural units

Cost utility - QALY


Cost benefit analysis of the enigma trial1

Cost-Benefit Analysis of the ENIGMA Trial

  • What is the financial cost of using nitrous oxide?

  • From the hospital administration’s point of view


Cost benefit n 2 o variable costs

Costs saved

Maintenance anaesthetic

Analgesia

Vasopressors

Expenses

PONV prophylaxis

PONV

Infection/fever

Pneumonia

Atelectasis

PACU

ICU

HLOS

Cost-benefit N2O: variable costs


Cost benefit n 2 o variable costs1

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


Contributing cost estimates1

Contributing Cost Estimates


Enigma cost benefit analysis results

ENIGMA Cost-Benefit Analysis: Results

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


Enigma cost benefit analysis sensitivity analysis

ENIGMA Cost-Benefit Analysis: Sensitivity Analysis

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


Cost benefit analysis limitations

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

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

Questions


Sensitivity analysis

Sensitivity Analysis


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