title: Cost-effectiveness analysis on spinal anesthesia versus local anesthesia plus sedation for loop colostomy closure.
abstract: BACKGROUND
  Studies in the area of health economics are still poorly explored and it is known that the cost savings in this area is becoming more necessary, provided that strict criteria.
  
  
  OBJECTIVE
  To perform a cost-effectiveness analysis of spinal anesthesia versus local anesthesia plus sedation for loop colostomy closure.
  
  
  METHODS
  This was a randomized clinical trial with 50 patients undergoing loop colostomy closure either under spinal anesthesia (n = 25) or under local anesthesia plus sedation (n = 25). The duration of the operation, time spent in the post-anesthesia recovery room, pain, postoperative complications, length of hospital stay, laboratory and imaging examinations and need for rehospitalization and reoperation were analyzed. The direct medical costs were analyzed. A decision tree model was constructed. The outcome measures were mean cost and cost per local and systemic postoperative complications avoided. Incremental cost-effectiveness ratios were presented.
  
  
  RESULTS
  Duration of operation: 146 +/- 111.5 min. vs 105 +/- 23.6 min. (P = 0.012); mean time spent in post-anesthesia recovery room: 145 +/- 110.8 min. vs 36.8 +/- 34.6 min. (P<0.001). Immediate postoperative pain was lower with local anesthesia plus sedation (P<0.05). Local and systemic complications were fewer with local anesthesia plus sedation (P = 0.209). Hospitalization + rehospitalization: 4.5 +/- 4.1 days vs 2.9 +/- 2.2 days (P<0.0001); mean spending per patient: R$ 5,038.05 vs 2,665.57 (P<0.001). Incremental cost-effectiveness ratio: R$ -474.78, indicating that the strategy with local anesthesia plus sedation is cost saving.
  
  
  CONCLUSIONS
  In the present investigation, loop colostomy closure under local anesthesia plus sedation was effective and appeared to be a dominant strategy, compared with the same surgical procedure under spinal anesthesia.
authors: Digestive System Surgery Mandaqui, Hospital Complex, São Paulo, SP, Brazil.
authors: Filinto Aníbal Alagia
authors: FA
authors: Vaz
authors: Rone Antônio Alves
authors: RA
authors: Abreu
authors: Patrícia Coelho de
authors: PC
authors: Soárez
authors: Manlio Basílio
authors: MB
authors: Speranzini
authors: Luís Cesar
authors: LC
authors: Fernandes
authors: Delcio
authors: D
authors: Matos
mesh_terms: D000328:Adult; D000772:Anesthesia, Local / Q000191:economics*; D000775:Anesthesia, Spinal / Q000191:economics*; D003125:Colostomy / Q000191:economics* / Q000379:methods; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D008297:Male; D017063:Outcome Assessment, Health Care / Q000191:economics; D013997:Time Factors