Cost implications of the practice of anaesthesiology

Sir: Recently, several studies have focused on the importance of the costs of anaesthesia [1-3]. These costs range from 3% to 8%, depending on the surgical procedure. Yet anaesthesiologists often practice in places other than the operating and recovery rooms [4]. In the European Community, especially in France, anaesthesiologists mainly look after the perioperative care in surgical wards and in surgical intensive care units. Their activities also concern the evaluation and treatment of post-operative pain. Drug costs due to the anaesthesiologists' prescriptions in those units are often not properly identified and are generally included into the surgical department budget instead of the anaesthesia department. Hence drug costs reduction strategies may be inappropriate if they do not properly identify the prescribers. The very importance of drug costs due to anaesthesiologists has not been studied in detail. In a recent prospective study (1-year period), we evaluated drug costs due to anaesthesiologists at different levels: operating rooms, recovery rooms, surgical intensive care unit (ICU; eight beds), post-operative surgical care. Our 350-bed teaching hospital includes five surgical departments (gastroenterology, orthopaedics, gynaecology, paediatrics and obstetrics). Drug costs were classified according to the following drug categories: opioid or nonopioid analgesics (AA), intravenous anaesthetics, benzodiazepines and neuromuscular blocking agents (ABN), volatile anaesthetics (VA), solutes and electrolytes (SE), antibiotics (AB), parenteral nutrition (PN), blood substitutes (BS), anticoagulants (AC) and vitamins (VI). Prescriptions for blood products were not included in the study. Results were expressed in percentages of the total drug costs in the surgical departments and according to the drug categories studied. Drug costs due to the anaesthesiologists were of 3 292 683 Francs, which represents 69.3% of total drug costs of the surgical departments. When the total drug cost due to anaesthesiologists was broken down, the results were: anaesthesia= 24.5%, surgical ICU = 26.2%, peri-operative care = 49.3%. The analysis according to drug categories showed that anaesthesiologists prescribed 78.1% of all the AA administered in the surgical wards, 82.1% of the ABN, 100% of the VA, 56.5% of the SE, 47.4% of the AB, 70.7% of the PN, 17.7% of the BS, 66.8% of the AC, 61.9% of the VI. In conclusion, this study showed that the drug costs prescribed by anaesthesiologists were 69.3% of the total drug cost of the surgical departments. Of course this rate may change because it depends on the nature of the surgical patients' case-mix. It also showed that the cost related to the practice of anaesthesiology, outside the operating rooms, was 50% of the drug costs incurred. Costs containment strategies must not ignore these points. The funding of anaesthesiology seems to be largely by default. The costs are inappropriately met by surgical and medical budgets. The lack of a defined budget may undermine the effectiveness of anaesthesiologists' practice and their forward planning. The Editor in Chief welcomes comments concerning the funding of anaesthesiology practice: how are expenditure records made and how is the allocation of funds calculated. J.-L.