title: Desflurane improves the throughput of patients in the PACU. A cost-effectiveness comparison with isoflurane.
abstract: OBJECTIVE
  In a pharmacoeconomic approach of anesthesia, postanesthesia care unit (PACU) occupancy can be chosen as a criteria of effectiveness to compare two anesthetic drugs with different rates of elimination and different costs of administration. Our objective was to develop a cost-effectiveness approach for the comparison of isoflurane (I) and desflurane (D).
  
  
  METHODS
  In this prospective observational study, 68 patients aged 18-70 received either D or I for maintenance of anesthesia for inpatient abdominal procedures. Length of stay (LOS) in PACU was collected by a blinded observer. After the relationship between duration of surgery and LOS in PACU had been established in the 68 observed patients, we estimated the PACU occupancy according to duration of surgery and time of admission in PACU using a computer model of 204 consecutive patients, based on the hypothesis of an exclusive use of either D or I. Outcome measures were direct costs of the anesthesia procedure and occupancy of the PACU.
  
  
  RESULTS
  The direct cost of the anesthetic was significantly higher with D than with I. This represents an increase of CAN$ 2 708 for the 204 patients. PACU occupancy was reduced by at least one patient (out of five beds) during 26.1% of the time with D (P <0.01).
  
  
  CONCLUSIONS
  Improving the throughput of patients in PACU by using new halogenated anesthetic agents with faster rates of elimination may outweigh the incremental cost of this strategy. This becomes particularly meaningful in operating theatres experiencing frequent overcrowded periods.
authors.affiliation: Department of Anesthesia and Intensive Care, St Antoine University Hospital, and the University Paris XIII, Paris, France. marc.beaussier@sat.ap-hop-paris.fr
authors.forename: Marc
authors.initials: M
authors.lastname: Beaussier
authors.forename: Anne
authors.initials: A
authors.lastname: Decorps
authors.forename: Patrick
authors.initials: P
authors.lastname: Tilleul
authors.forename: Alexandre
authors.initials: A
authors.lastname: Megnigbeto
authors.forename: Pierre
authors.initials: P
authors.lastname: Balladur
authors.forename: André
authors.initials: A
authors.lastname: Lienhart
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000769:Anesthesia, Inhalation / Q000191:economics*; D000777:Anesthetics / Q000191:economics*; D003362:Cost-Benefit Analysis; D003365:Costs and Cost Analysis; D000077335:Desflurane; D004311:Double-Blind Method; D016527:Drug Costs; D005260:Female; D006801:Humans; D007530:Isoflurane / Q000031:analogs & derivatives / Q000191:economics*; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care / Q000191:economics*; D016896:Treatment Outcome
chemical_list: D000777:Anesthetics; D000077335:Desflurane; D007530:Isoflurane