Analysis of the cost-effectiveness of remifentanil-based general anesthesia: a survey of clinical economics under the Japanese health care system.
OBJECTIVE
Remifentanil has been available in Japan for 3 years. The use of this new opioid is considered a useful adjuvant to general anesthesia. Knowing the exact cost-effectiveness of remifentanil should lead to improved anesthetic outcomes with a reasonable cost.


METHODS
This single-blinded, prospective, randomized study compared the cost of remifentanil-based general anesthesia combined with isoflurane, sevoflurane, or propofol with fentanyl-based conventional techniques in 210 women who underwent breast surgeries.


RESULTS
Remifentanil-based general anesthesia was no more expensive than fentanyl-based conventional anesthesia. Postoperative nausea and vomiting was significantly less frequent after remifentanil-based than fentanyl-based anesthesia.


CONCLUSIONS
This study shows that remifentanil-based general anesthesia is no more expensive than conventional fentanyl-based anesthesia under the Japanese health care system because of the small difference in price between remifentanil and fentanyl.
Nakada
Takeo
T
Department of Health Policy Science, Tokyo Medical and Dental University Graduate School, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan. tmnakada@yahoo.com.sg
Ikeda
Daisuke
D
Yokota
Miyuki
M
Kawahara
Kazuo
K
D000759:Adjuvants, Anesthesia / Q000191:economics; D000328:Adult; D000368:Aged; D000768:Anesthesia, General / Q000191:economics*; D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous / Q000191:economics*; D001794:Blood Pressure / Q000187:drug effects; D003362:Cost-Benefit Analysis; D003695:Delivery of Health Care / Q000191:economics; D005260:Female; D005283:Fentanyl / Q000191:economics; D006801:Humans; D007564:Japan; D008297:Male; D008738:Methyl Ethers; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D009313:National Health Programs; D009609:Nitrous Oxide; D010880:Piperidines / Q000191:economics*; D020250:Postoperative Nausea and Vomiting / Q000191:economics / Q000453:epidemiology; D015742:Propofol; D011446:Prospective Studies; D000077208:Remifentanil; D000077149:Sevoflurane; D016037:Single-Blind Method; D016896:Treatment Outcome
D000759:Adjuvants, Anesthesia; D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D008738:Methyl Ethers; D010880:Piperidines; D000077149:Sevoflurane; D009609:Nitrous Oxide; D000077208:Remifentanil; D005283:Fentanyl; D015742:Propofol
Curr Opin Anaesthesiol. 2002 Jun;15(3):359-63
17019226
Anesth Analg. 2000 Dec;91(6):1420-5
11093992
Anesth Analg. 2006 Jun;102(6):1884-98
16717343
Handb Exp Pharmacol. 2008;(182):283-311
18175097
Anesth Analg. 2004 Mar;98(3):750-7, table of contents
14980932
Toxicol Sci. 2006 Apr;90(2):419-31
16384817
Anesth Analg. 1998 Mar;86(3):504-9
9495402
Acta Anaesthesiol Scand. 2002 Nov;46(10):1251-60
12421198
Br J Anaesth. 2001 Oct;87(4):559-63
11878724
Anaesthesia. 2010 Apr;65(4):379-87
20151955
Science. 2009 Oct 2;326(5949):123-5
19713491
Saudi Med J. 2009 Jun;30(6):778-82
19526159