Washington—Anesthesia costs can differ by as much as 10-fold between similar cases, suggesting significant variability in how clinicians handle medications in the operating room, new research has found.

The wide variations in drug use, and consequent costs, among anesthesia providers during similar cases are both an opportunity to minimize waste and a teaching opportunity, according to the researchers.

Doug Hester, MD, an assistant professor of anesthesiology at Vanderbilt University Medical Center, in Nashville, Tenn., said the study began as part of a multicenter effort aimed at decreasing the average cost of anesthesia for surgery at two large academic medical centers. The investigators created an automated cost calculator for medications administered during surgical cases, then identified both the median drug cost for any given procedure as well as the degree of variability attributable to different anesthesia providers. “So, in order to effect behavioral change, we need to educate those providers about their costs for any given case,” Dr. Hester said. “And in order to do that, we need to create a good system to deliver that cost to them.”

The researchers began by obtaining acquisition costs of all intraoperative medications from the institutions’ pharmacies. They then developed a series of database queries to automatically obtain and calculate cost-per-case totals using the facility’s anesthesia information management system. Data were extracted regarding the amount of drug given by bolus, infusion or inhalation. These amounts were then indexed with the drug’s acquisition cost, providing a total cost per case and cost per minute.

“We had to create a process that would calculate costs in real time and be delivered to the anesthesia provider in the room,” said Dr. Hester, who presented the findings at the annual meeting of the American Society of Anesthesiologists (abstract 165). “This info is not typically known by providers.”

Dr. Hester and his colleagues presented data from the first set of diagnostic codes analyzed, total knee arthroplasty. They found that median cost for 449 cases was $22.98, $24.29 at institution A (229 cases) and $20.23 at institution B (220 cases). Perhaps more importantly, anesthetic costs ranged widely among providers, from $7.99 to $81.77.

“The idea is to then communicate with providers both the mean cost and their specific cost for any particular [diagnostic] code,” Dr. Hester explained. “And we are hoping that this would spur behavioral changes regarding the stewardship of pharmacologic costs, assuming it doesn’t affect outcomes.”

The investigators also plan to combine this information with quality indicators to quantify value in anesthetic care. “If we could save $10 on every case we do, we would save about half a million dollars every year,” he said.

Pharmacists Can Help

Asked to comment on the study, Tricia A. Meyer, MS, PharmD, FASHP, the senior director of the Department of Pharmacy at Scott & White Healthcare, in Temple, Texas, said that “it would be helpful to know exactly which drugs the researchers used to calculate spending; local anesthetics, antiemetics, pain medications, metoclopramide, gases, metoprolol, etc., all could be a target of potential analysis and subsequent cost-control efforts.” That caveat aside, “this is an interesting, highly relevant and hot topic. It does make sense to compare costs across the different hospitals in a system and use best practices when containing costs.”

At Scott & White, Dr. Meyer said, “we periodically will take the top 10 to 20 drugs used by anesthesia along with the acquisition cost and set it up in a table format, and place copies inside the lid of the anesthesia kit so everyone (anesthesia providers) can see current prices. It is a good practice to keep everyone aware of the costs because they change frequently with different manufacturers, or we switch from a branded to generic product, or a drug shortage occurs and the compounded price is typically considerably higher.”

There’s no one best way to analyze and manage pharmacy spending, noted Dr. Meyer, who also is an associate professor of anesthesiology for the Department of Anesthesiology at the Texas A&M University College of Medicine at the Temple campus. “Many hospitals are seeing volume decreases in admits and surgeries,” she said. “Patients are struggling with high deductibles and more out-of-pocket expenses and therefore delaying treatment. So this is an important challenge for both patients and facilities that vigilant pharmacists can help meet.”

In fact, “hospitals have already managed the ‘low-hanging fruit’ as far as cost savings,” she noted. “Therefore, any new ideas or strategies that show savings should be considered, evaluated and implemented—provided that they truly cut costs without adding an extra expense or drain on staff resources.”

—Additional reporting by David Bronstein