Anaesthesia drug cost, control and utilization in Canada

Purpose: To investigate the attitudes of senior anaesthetists toward issues of anaesthesia drug cost control, utilization, and education, and to determine patterns of drug use of common clinical scenarios. Methods: A questionnaire mailed to heads of anaesthesia departments in all large (>200 beds) Canadian hospitals (n = 187). Data were analyzed with chi-square and t tests; P < 0.05 was considered significant. Results: Sixty-eight per cent responded to the questionnaire. Ninety-four per cent considered cost when choosing anaesthetic agents, 63.7% indicated cheaper drugs could be used without decreasing quality of care, and 46.3% that restricted access to expensive agents was justified. Only 32.8% of hospitals currently imposed restrictions. Departmental practice guidelines were favoured by 82.1% of respondents. Fifty-three per cent considered resident education about drug cost to be inadequate and 57.4% indicated that resident teaching justified the use of expensive agents. Most respondents (69.8-96.8%) felt they knew the cost of commonly used agents, many made considerable use of cheaper agents such as halothane, curare and morphine, and 61% re-used syringes containing residual drug. A few differences between teaching and non-teaching hospitals anaesthetists were identified. These anaesthetists demonstrated awareness of pharmacoeconomic issues, believed that cheaper anaesthetic agents could be used without compromising quality of care, identified Sew hospitals with policies that restricted drug use, and indicated drug cost education could be improved. Control and responsibility of drug utilization were shared within their hospitals. Many approved the idea of practice guidelines. In common clinical scenarios cheaper agents were preferred and syringe re-use was surprisingly common.