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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

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 trial results
ENIGMA Trial Results

Kaplan-Meier estimates of discharge from the intensive care unit

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 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
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
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