title: $1.8 Million and counting: how volatile agent education has decreased our spending $1000 per day.
abstract: OBJECTIVE
  Volatile anesthetic agents comprise a substantial portion of every hospital's pharmacy budget. Challenged with an initiative to lower anesthetic drug expenditures, we developed an education-based intervention focused on reducing volatile anesthetic costs while preserving access to all available volatile anesthetics. When postintervention evaluation demonstrated a dramatic year-over-year reduction in volatile agent acquisition costs, we undertook a retrospective analysis of volatile anesthetic purchasing data using time series analysis to determine the impact of our educational initiative.
  
  
  METHODS
  We obtained detailed volatile anesthetic purchasing data from the Central Supply of Wake Forest Baptist Health from 2007 to 2014 and integrated these data with the time course of our educational intervention.
  
  
  METHODS
  Aggregate volatile anesthetic purchasing data were analyzed for 7 consecutive fiscal years.
  
  
  METHODS
  The educational initiative emphasized tissue partition coefficients of volatile anesthetics in adipose tissue and muscle and their impact on case management.
  
  
  METHODS
  We used an interrupted time series analysis of monthly cost per unit data using autoregressive integrated moving average modeling, with the monthly cost per unit being the amount spent per bottle of anesthetic agent per month.
  
  
  RESULTS
  The cost per unit decreased significantly after the intervention (t=-6.73, P<.001). The autoregressive integrated moving average model predicted that the average cost per unit decreased $48 after the intervention, with 95% confidence interval of $34 to $62. As evident from the data, the purchasing of desflurane and sevoflurane decreased, whereas that of isoflurane increased.
  
  
  CONCLUSIONS
  An educational initiative focused solely on the selection of volatile anesthetic agent per case significantly reduced volatile anesthetic expense at a tertiary medical center. This approach appears promising for application in other hospitals in the rapidly evolving, value-added health care environment. We were able to accomplish this with instruction on tissue partition coefficients and each agent's individual cost per MAC-hour delivered.
authors.affiliation: Anesthesiology, Wake Forest School of Medicine, Winston-Salem, NC, USA. Electronic address: scmiller@wakehealth.edu.
authors.forename: Scott A
authors.initials: SA
authors.lastname: Miller
authors.affiliation: Anesthesiology, Wake Forest School of Medicine, Winston-Salem, NC, USA. Electronic address: caschenb@wakehealth.edu.
authors.forename: Carol A
authors.initials: CA
authors.lastname: Aschenbrenner
authors.affiliation: Anesthesiology, Wake Forest School of Medicine, Winston-Salem, NC, USA. Electronic address: jtrauner@wakehealth.edu.
authors.forename: Justin R
authors.initials: JR
authors.lastname: Traunero
authors.affiliation: Anesthesiology, Wake Forest School of Medicine, Winston-Salem, NC, USA. Electronic address: lbauman@wakehealth.edu.
authors.forename: Loren A
authors.initials: LA
authors.lastname: Bauman
authors.affiliation: Anesthesiology, Wake Forest School of Medicine, Winston-Salem, NC, USA. Electronic address: sam.lobell@gmail.com.
authors.forename: Samuel S
authors.initials: SS
authors.lastname: Lobell
authors.affiliation: Anesthesiology, Wake Forest School of Medicine, Winston-Salem, NC, USA. Electronic address: jkelly@wakehealth.edu.
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Kelly
authors.affiliation: Anesthesiology, Wake Forest School of Medicine, Winston-Salem, NC, USA. Electronic address: jereynol@wakehealth.edu.
authors.forename: John E
authors.initials: JE
authors.lastname: Reynolds
mesh_terms: D000769:Anesthesia, Inhalation / Q000295:instrumentation / Q000379:methods*; D000072080:Anesthesiologists / Q000193:education; D000776:Anesthesiology / Q000193:education*; D018685:Anesthetics, Inhalation / Q000008:administration & dosage / Q000191:economics*; D000072077:Anesthetists / Q000193:education; D017046:Cost Savings / Q000191:economics*; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006801:Humans; D007396:Internship and Residency; D010607:Pharmacy Service, Hospital / Q000191:economics*; D012189:Retrospective Studies; D055549:Volatile Organic Compounds / Q000008:administration & dosage / Q000191:economics*
chemical_list: D018685:Anesthetics, Inhalation; D055549:Volatile Organic Compounds
keywords: Desflurane; Drug costs; Economic models; Inhaled anesthetics; Isoflurane; Sevoflurane