To measure drug costs, look at big picture
To measure drug costs, look at big picture
With managed care breathing down the necks of most same-day surgery managers, determining cost-effective choices for ambulatory anesthesia has become a priority. But what do you need to look at to determine costs?
Anesthesia experts emphasize that you shouldn’t just measure drug costs, but total costs.
Same-day surgery managers may find that more expensive, short-acting drugs, such as propofol, are more cost-effective in the long run than less expensive, long-acting drugs, says Bertil Wagner, PharmD, assistant professor of pharmacy practice at Rutgers University College of Pharmacy in Piscataway, NJ. (For more on propofol, see Same-Day Surgery, November 1995, p. 134.)
"The point is that you shouldn’t only look at drug costs but also drug pharmacology as well as associated costs, including recovery," Wagner says.
When measuring the total costs of anesthesia drugs, consider the following factors:
• OR and recovery costs.
Anesthesia drug costs "start when the patient is anesthetized and end when the patient is wheeled out from OR," Wagner says. Also, recovery room costs may be affected, depending on the medication, he points out. The costs of these areas include not only supplies, but also labor.
• Side effects.
Do the drugs you’re using cause the patients to stay longer at your facility? Narcotics, for example, may have more post-op nausea and vomiting that can prolong stage 1 and stage 2 recovery, thus increasing costs, Wagner points out. Propofol would be an alternative that could cause less post-op nausea.
• Pharmacy markup: acquisition costs vs. patient charges.1
"The pharmacy has to cover the costs of storing and dispensing drugs, their space and their personnel, and their stockpile inventory," says Beverly K. Philip, MD, associate professor of anesthesia at Harvard Medical School and director of the Day Surgery Unit at Brigham and Women’s Hospital in Boston.
• Costs of preparation: dilution, refrigeration, and control.
With narcotics, be sure to consider the cost in terms of time and labor to fill out the extensive paperwork required by government, Philip suggests. Other cost factors include refrigeration, time to dilute drugs that come in powder form, and equipment to dilute it.
• Costs billed to different budgets: pharmacy vs. hospital supplies vs. anesthesia department.
Often, not all anesthesia items are on the same budget, Philip points out. For example, narcotics may be on the pharmacy budget because of control issues. Inhaled drugs, however, may be purchased by the anesthesia department.
"You don’t know where the entire costs are unless you look in all relevant budgets," Philip says.
• Costs of waste due to package size vs. unit dose.
A package may contain more doses than one patient uses, Philip points out. Propofol is just one example.
• Cost of equipment: pumps, vaporizers, and monitors.
When analyzing the costs of equipment, look at acquisition and maintenance, Philip suggests. Consider whether you have to hire personnel to maintain the equipment or outsource.
Figure in satisfaction, too
While all these factors are important in determining costs, don’t neglect to consider patient and physician satisfaction, Philip emphasizes. "It is better to list satisfaction separately, but satisfaction is difficult to quantify," she acknowledges.
Wagner agrees, and says same-day surgery programs may have to ask specific questions such as: Did you have a pleasant awakening? Did you experience nausea and vomiting? How severe was it?
Asking such questions can pay off in the long run for the same-day surgery program, Wagner points out. "An unhappy patient will not come back to same surgeon for surgery," he points out.
Reference
Philip BK. Practical cost-effective choices: Ambulatory general anesthesia. Table 1: Hidden costs associated with anesthetic agents. J Clin Anesth 1995; 6:606-613.
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