The cost-effectiveness of an outpatient anesthesia consultation clinic before surgery: a matched Hong Kong cohort study (original) (raw)
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Cost Effectiveness of Physician Anesthesia
2013
Introduction The question of whether anesthesiologists are cost-effective providers of anesthesia services remains an open question in the minds of some of our medical colleagues, the allied health community, the political and regulatory class, and the public. There have been recent publications that claim that there is no difference in outcomes between anesthetics delivered by anesthesiologists versus those delivered by nurse anesthetists and since nurses are paid less than physicians that anesthesiologists are not cost-effective [1-3]. In a medical environment with rapidly narrowing margins, replacing physicians with nurses could be an attractive option to some medical facilities.
The Effect of Consultations on the Cost of Pre-Anesthetic Assessment
International Journal of Clinical Medicine, 2013
Background: In our study, researching the distribution of the consultations other than anaesthesia in compliance with the disciplines and ages of the patients and its effect on the assessment cost has been aimed. Methods: Our study has been conducted during 8 months by the retrospective assessment of the records of 3844 cases on which an elective surgical procedure was planned in the anesthesiology polyclinic of Firat University Hospital. The records of patients have been obtained through examining their files from the hospital record system. Results: The total number of patients whose consultations have been demanded was 367 (9.5%) and the number of male/female was 192/175. The number of cases about which more than one consultation has been demanded was determined as 87 (2.2%). The number of cases on which a method change for the anaesthesia was applied was 21 (5.7%), and the number of cases whose surgery was cancelled was 3 (0.81%). Requested consultation for each patient, the consultations of cardiology, chest diseases and internal medicine bring an additional cost on the total sum respectively as 37.2 TL (28.61 ),29.8TL(22.92), 29.8 TL (22.92 ),29.8TL(22.92) and 19.9 TL (15.30 $). Conclusions: We suggest that the cost analysis should be absolutely taken into consideration during the pre-anaesthetic assessment for the requirement of routine examinations.
Operative Outcome And Hospital Cost
Journal of Thoracic and Cardiovascular Surgery, 1998
Because of concern about increasing health care costs, we undertook a study to find patient risk factors associated with increased hospital costs and to evaluate the relationship between increased cost and in-hospital mortality and serious morbidity. Methods: More than 100 patient variables were screened in 1221 patients undergoing cardiac procedures. Simultaneously, patient hospital costs were computed from the cost-to-charge ratio. Univariate and multivariate statistics were used to explore the relationship between hospital cost and patient outcomes, including operative death, in-hospital morbidity, and length of stay. Results: The greatest costs were for 31 patients who did not survive operation ($74,466, 95% confidence interval 27,102to27,102 to 27,102to198,025), greater than the costs for 120 patients who had serious, nonfatal morbidity ($60,335, 95% confidence interval 28,381to28,381 to 28,381to130,897, p ؍ 0.02) and those for 1070 patients who survived operation without complication ($31,459, 95% confidence interval 21,944to21,944 to 21,944to49,849, p ؍ 0.001). Breakdown of the components of hospital costs in fatalities and in cases with nonfatal complications revealed that the greatest contributions were in anesthesia and operating room costs. Significant (by stepwise linear regression analysis) independent risks for increased hospital cost were as follows (in order of decreasing importance): (1) preoperative congestive heart failure, (2) serum creatinine level greater than 2.5 mg/dl, (3) New York state predicted mortality risk, (4), type of operation (coronary artery bypass grafting, valve, valve plus coronary artery bypass grafting, or other), (5) preoperative hematocrit, (6) need for reoperative procedure, (7) operative priority, and (8) sex. These risks were different than those for in-hospitality death or increased length of stay. Hospital cost correlated with length of stay (r ؍ 0.63, p < 0.001), but there were many outliers at the high end of the hospital cost spectrum. Conclusions: We conclude that operative death is the most costly outcome; length of stay is an unreliable indicator of hospital cost, especially at the high end of the cost spectrum; risks of increased hospital cost are different than those for perioperative mortality or increased length of stay; and ventricular dysfunction in elderly patients undergoing urgent operations for other than coronary disease is associated with increased cost. Certain patient factors, such as preoperative anemia and congestive heart failure, are amenable to preoperative intervention to reduce costs, and a high-risk patient profile can serve as a target for cost-reduction strategies. (J Thorac Cardiovasc Surg 1998;115:593-603) Ferraris, Ferraris, Singh 5 9 5 CHF, Congestive heart failure; OR, operating room.
Cost-Conscious of Anesthesia Physicians is Enough? Awareness Survey
Pakistan Journal of Medical Sciences, 2015
the approval of the local ethics committee. Overall 149 anesthetists were included in the study. Participants were asked to estimate the cost of 30 products used by anesthesiology and intensive care units. Results: One hundred forty nine doctors, 45% female and 55% male, participated in this study. Of the total 30 questions the averages of cost estimations were 5.8% accurate estimation, 35.13% underestimation and 59.16% overestimation. When the participants were divided into the different groups of institution, duration of working in this profession and sex, there were no statistically significant differences regarding accurate estimation. However, there was statistically significant difference in underestimation. In underestimation, there was no significant difference between 16-20 year group and >20 year group but these two groups have more price overestimation than the other groups (p=0.031). Furthermore, when all the participants were evaluated there were no significant difference between age-accurate cost estimation and profession time-accurate cost estimation. Conclusion:Anesthesiology and intensive care physicians in this survey have an insufficient awareness of the cost of the drugs and materials that they use. The institution and experience are not effective factors for accurate estimate. Programs for improving the health workers knowledge creating awareness of cost should be planned in order to use the resources more efficiently and cost effectively,
Anesthesiology Clinics, 2009
Most financial analysis regarding the cost of non-operating room (non-OR) anesthesia in hospitals is incorrect. This statement is strong, but this article indicates why this situation exists and suggests how to perform the cost analysis in the right way. It also reviews financial and operational strategies that can result in more efficient scheduling of anesthesia, thereby freeing up anesthesiologist time in the main OR for non-OR needs.
Anaesthesia, 2003
We compared the cost-effectiveness of general anaesthetic agents in adult and paediatric day surgery populations. We randomly assigned 1063 adult and 322 paediatric elective patients to one of four (adult) or two (paediatric) anaesthesia groups. Total costs were calculated from individual patient resource use to 7 days post discharge. Incremental cost-effectiveness ratios were expressed as cost per episode of postoperative nausea and vomiting (PONV) avoided. In adults, variable secondary care costs were higher for propofol induction and propofol maintenance (propofol ⁄ propofol; p < 0.01) than other groups and lower in propofol induction and isoflurane maintenance (propofol ⁄ isoflurane; p < 0.01). In both studies, predischarge PONV was higher if sevoflurane ⁄ sevoflurane (p < 0.01) was used compared with use of propofol for induction. In both studies, there was no difference in postdischarge outcomes at Day 7. Sevoflurane ⁄ sevoflurane was more costly with higher PONV rates in both studies. In adults, the cost per extra episode of PONV avoided was £296 (propofol ⁄ propofol vs. propofol ⁄ sevoflurane) and £333 (propofol ⁄ sevoflurane vs. propofol ⁄ isoflurane).