Cost-Effectiveness of Propofol (Diprivan) Versus Inhalational Anesthetics to Maintain General Anesthesia in Noncardiac Surgery in the United States

• Published in: Value in health Vol. 24; no. 7; pp. 939 - 947
• Main Authors: Kampmeier, Tim, Rehberg, Sebastian, Omar Alsaleh, Abdul Jabbar, Schraag, Stefan, Pham, Jenny, Westphal, Martin
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.07.2021; Elsevier Science Ltd
• Subjects: Ambulatory care; Analgesics; Anesthesia; Anesthesia, General; Anesthetics; Anesthetics, Inhalation; Antiemetics; Clinical trials; Cost analysis; Cost-Benefit Analysis; cost-effectiveness; Diprivan; Economic impact; Efficacy; General Surgery; Health care; Humans; Hypnotics and Sedatives - administration & dosage; Hypnotics and Sedatives - economics; inhalation anesthesia; Inpatient care; Intravenous administration; intravenous anesthesia; Muscle relaxants; Nausea; Patients; PONV; Postoperative nausea; Propofol; Propofol - economics; Randomized Controlled Trials as Topic; Risk reduction; Robustness; Sensitivity analysis; Side effects; Surgery; Vomiting; United States > US; intravenous anesthesia; cost-effectiveness; PONV; inhalation anesthesia; Diprivan; propofol
• ISSN: 1098-3015; 1524-4733
• DOI: 10.1016/j.jval.2021.01.008

It is not known whether using propofol total intravenous anaesthesia (TIVA) to reduce incidence of postoperative nausea and vomiting (PONV) is cost-effective. We assessed the economic impact of propofol TIVA versus inhalational anesthesia in adult patients for ambulatory and inpatient procedures relevant to the US healthcare system. Two models simulate individual patient pathways through inpatient and ambulatory surgery with propofol TIVA or inhalational anesthesia with economic inputs from studies on adult surgical US patients. Efficacy inputs were obtained from a meta-analysis of randomized controlled trials. Probabilistic and deterministic sensitivity analyses assessed the robustness of the model estimates. Lower PONV rate, shorter stay in the post-anesthesia care unit, and reduced need for rescue antiemetics offset the higher costs for anesthetics, analgesics, and muscle relaxants with propofol TIVA and reduced cost by 11.41 ± 10.73 USD per patient in the inpatient model and 11.25 ± 9.81 USD in the ambulatory patient model. Sensitivity analyses demonstrated strong robustness of the results. Maintenance of general anesthesia with propofol was cost-saving compared to inhalational anesthesia in both inpatient and ambulatory surgical settings in the United States. These economic results support current guideline recommendations, which endorse propofol TIVA to reduce PONV risk and enhance postoperative recovery. •Anesthesia maintenance with propofol reduces postoperative nausea and vomiting risk but incurs higher drug costs than inhalational anesthesia.•Our pharmacoeconomic model demonstrates that overall cost is reduced with propofol anesthesia compared to inhalational anesthesia in both inpatient and ambulatory surgical settings.