Pharmacoeconomics of propofol in anesthesia

Pharmacoeconomic data on the use of propofol in anesthesia are reviewed, with consideration of clinical characteristics that affect overall costs. Propofol is more expensive than many other anesthetics but its use can affect the costs of perioperative care as well as costs not directly related to the health care system, such as those associated with time off work. Using propofol can result in earlier discharge from the postanesthesia care unit (PACU), which can result in lower PACU costs. Anesthesia induction and maintenance with propofol versus barbiturates for induction and volatile anesthetics for maintenance have been associated with a lower frequency of postoperative nausea and vomiting (PONV) in the immediate postoperative period. A reduced frequency of PONV may improve the ability to increase patient flow through the PACU, which may reduce PACU costs. The cost of treating PONV in the PACU might not be high enough to justify the use of more expensive agents such as propofol solely for their reduced propensity to cause PONV. Propofol use has been associated with significantly shorter times to extubation of cardiac-surgery patients compared with the use of other agents. Early extubation has, in turn, been associated with shorter hospital stays, shorter stays in the cardiac intensive care unit, and lower hospital charges. Policy changes regarding criteria for discharge from the PACU may need to be implemented if the economic advantages of propofol are to be realized. Anesthesia with propofol, compared with other agents, has been associated with shorter stays in the PACU. Whether using propofol decreases the costs of care is unclear.