EVALUATION OF COST MINIMIZATION STRATEGIES OF ANESTHETIC DRUGS IN A TERTIARY CARE HOSPITAL

A survey was undertaken to compare anaesthetic drug expenditures over a three-year period, to evaluate the impact of strategies offered to curtain continuously rising drug costs. Suggestions to control rising expenditures were based primarily on education of staff and residents regarding drug costs, emphasizing rational use of the more expensive drugs, and minimizing drug wastage. To assess the impact of these measures, a review of annual hospital budgets, global pharmacy expenditures, and anaesthetic drug expenditures was conducted for the period 1991 to 1993. Both absolute and proportional costs of anaesthetic drugs were compared, by year according to six major classes: opioid analgesics (OA), muscle relaxants (MR) inhalational anaesthetic drugs(INH), intravenous anaesthetic drugs (IV), local anaesthetic drugs (LA) and a category labelled other drugs (OTH). In addition, the utilization patterns and unit price changes were compared for each drug for the periods 1991-92, and 1992-93. Total hospital drug costs increased from $7.1M to $8.5M over the three years. During the same period, the cost of anaesthetic drugs decreased from $379K to $361K, despite an augmentation in annual case load from 12,507 to 13,076 surgical procedures. For the entire survey period, the mean cumulative anaesthetic drug cost was 4.6% of the pharmacy budget, or 0.24% of the hospital budget. Analysis by drug class revealed a $51K decrease in expenditures on OA, due to decreased utilization of fentanyl and alfentanil, and a decrease in the price of fentanyl. The increased expenditure on INH drugs was primarily due to an increase in acquisition costs. The introduction of the new iv anaesthetic drugs ($34K increase) had minimal effect on overall drug expenditures. We conclude that the implementation of simple measures such as the education of anaesthesia personnel regarding drug costs, and decreasing drug wastage, can be an effective means of controlling drug expenditures, at a time when new drugs and techniques are being introduced The pharmacoeconomic benefits of such efforts must consider overall cost-effectiveness, including the duration and quality of recovery.