Clinical and economic factors important to anaesthetic choice for day-case surgery.


:Clinical and economic factors that are important to consider when selecting anaesthesia for day-case surgery can differ from those for inpatient anaesthesia. Patients undergoing day-case surgery tend to be healthier and have shorter durations of surgery. They expect less anxiety before surgery, amnesia for the surgical experience, a rapid return to normal (normal mentation with minimal pain and nausea) after surgery, and lower expenses. However, the latter 2 expectations can conflict; older generic drugs have lower acquisition costs but often impose longer recovery times. Longer recovery periods can increase costs by prolonging the time to discharge from labour-intensive areas such as the operating suite or the post-anaesthesia recovery unit. The challenge for today's anaesthetist is to use newer drugs judiciously to minimise their expense without compromising the rate or quality of recovery. Several approaches can secure these aims. Most apply the least anaesthetic needed. 'Least anaesthetic' may mean the particular form of anaesthetic (e.g. local infiltration with monitored anaesthesia care versus a general anaesthetic), or may mean the delivery of the smallest effective dose, perhaps guided by anaesthetic monitors such as end-tidal analysers or the bispectral index. For patients requiring general anaesthesia, a combination of several drugs usually secures the closest approach to the ideal. Drug combinations used usually include a short-acting properative anxiolytic (e.g. midazolam), intravenous propofol (a short-acting potent anxiolytic and amnestic agent) for induction of anaesthesia (and sometimes for maintenance) and primary maintenance of anaesthesia with inhaled nitrous oxide combined with a poorly soluble (low solubility produces rapid recovery; the least soluble is desflurane) potent inhaled anaesthetic delivered at a low inflow rate (to minimise cost). Although old, nitrous oxide is inexpensive and has favourable pharmacokinetic and cardiovascular advantages; however, it is limited in its anaesthetic/amnestic potency, and has the capacity to increase nausea. In children, induction of anaesthesia is often accomplished with sevoflurane rather than desflurane; although sevoflurane is modestly more soluble than desflurane, it is non-pungent whereas desflurane is pungent. Moderate- or short-acting opioids (fentanyl is popular) or nonsteroidal anti-inflammatory agents (especially ketorolac), or local anaesthetics are added to secure analgesia during and after surgery. Similarly, when needed, moderate- or short-acting muscle relaxants are selected. Before the end of anaesthesia, an intravenous antiemetic may be given. With this drug combination, patients usually awaken within minutes after anaesthesia and can often move themselves to the vehicle for transport to the recovery unit. These combinations of anaesthetics and techniques minimise use of expensive drugs while expediting recovery (again minimising cost) with minimal or no compromise in the quality of recovery.






Eger EI,White PF,Bogetz MS




Has Abstract


2000-03-01 00:00:00












  • Testing the validity of cost-effectiveness models.

    abstract::A growing body of recent work has identified several problems with economic evaluations undertaken alongside controlled trials that can have potentially serious impacts on the ability of decision makers to draw valid conclusions. At the same time, the use of cost-effectiveness models has been drawn into question, due ...


    pub_type: 杂志文章,评审


    authors: McCabe C,Dixon S

    更新日期:2000-05-01 00:00:00

  • The cost effectiveness of amoxicillin/clavulanic acid as antibacterial prophylaxis in abdominal and gynaecological surgery.

    abstract::The objective of this study was to compare the cost effectiveness of amoxicillin/clavulanic acid with other antibacterial regimens for prophylaxis of infection after elective abdominal or gynaecological surgery. Data from 21 previously published comparative clinical trials were used to calculate statistical confidence...


    pub_type: 临床试验,杂志文章


    authors: Davey PG,Parker SE,Crombie IK,Jaderberg M

    更新日期:1995-04-01 00:00:00

  • Generic clozapine: a cost-saving alternative to brand name clozapine?

    abstract::As a consequence of its prevalence, early onset and chronicity, schizophrenia imposes clinical and economic impediments to healthcare practitioners and society alike. Among the many antipsychotics available to treat the symptoms of this devastating illness, clozapine has emerged and differentiated itself from the othe...


    pub_type: 杂志文章,评审


    authors: Tse G,Thompson D,Procyshyn RM

    更新日期:2003-01-01 00:00:00

  • Patient-level estimates of the cost of complications in diabetes in a managed-care population.

    abstract:OBJECTIVE:To develop incidence-based estimates of the cost of several diabetes-related complications. DESIGN AND SETTING:This was a retrospective cohort study in a large health maintenance organisation. A total of 8905 patients with type 1 (insulin-dependent) and type 2 (non-insulin-dependent) diabetes mellitus and 36...


    pub_type: 临床试验,杂志文章


    authors: Ramsey SD,Newton K,Blough D,McCulloch DK,Sandhu N,Wagner EH

    更新日期:1999-09-01 00:00:00

  • Time trends and determinants of pharmaceutical expenditure in China (1990-2009).

    abstract:BACKGROUND:Pharmaceutical policy reform is currently one of the primary areas of health reform in China. The national pharmaceutical policy of China has multiple objectives: to develop the domestic pharmaceutical industry and encourage innovation, to control escalation of total pharmaceutical expenditures (TPE) which c...


    pub_type: 杂志文章


    authors: Shi L,Yang HY,Cheng G,Meng Q

    更新日期:2014-03-01 00:00:00

  • The role of pharmacoeconomic evaluations in disease management.

    abstract::Disease management is a systematic approach to a health condition or a healthcare intervention that organises preventative, interventional and care approaches throughout the continuum of care and which measures outcomes in terms of populations, not individuals. Disease management's advantage over the current component...


    pub_type: 杂志文章,评审


    authors: Chang K,Nash D

    更新日期:1998-07-01 00:00:00

  • Cost effectiveness in the treatment of heart failure with ramipril. A Swedish substudy of the AIRE study. Acute Infarction Ramipril Efficacy.

    abstract::We estimated the cost effectiveness of adding the ACE inhibitor ramipril to conventional treatment in patients with heart failure after acute myocardial infarction. These estimates were based on the Acute Infarction Ramipril Efficacy (AIRE) study and on complementary Swedish healthcare resource use data for a subset o...


    pub_type: 临床试验,杂志文章


    authors: Erhardt L,Ball S,Andersson F,Bergentoft P,Martinez C

    更新日期:1997-08-01 00:00:00

  • Discounting in Economic Evaluations.

    abstract::Appropriate discounting rules in economic evaluations have received considerable attention in the literature and in national guidelines for economic evaluations. Rightfully so, as discounting can be quite influential on the outcomes of economic evaluations. The most prominent controversies regarding discounting involv...


    pub_type: 杂志文章,评审


    authors: Attema AE,Brouwer WBF,Claxton K

    更新日期:2018-07-01 00:00:00

  • Temporary authorization for use: does the French patient access programme for unlicensed medicines impact market access after formal licensing?

    abstract:BACKGROUND:To reach the French market, a new drug requires a marketing authorization (MA) and price and reimbursement agreements. These hurdles could delay access to new and promising drugs. Since 1992, French law authorizes the use of unlicensed drugs on an exceptional and temporary basis through a compassionate-use p...


    pub_type: 杂志文章


    authors: Degrassat-Théas A,Paubel P,Parent de Curzon O,Le Pen C,Sinègre M

    更新日期:2013-04-01 00:00:00

  • The future of health technology assessment in healthcare decision making in Asia.

    abstract::Most countries have healthcare resource constraints and it is easy to identify new health technologies as an area in need of resource management, particularly given that new health technologies usually increase rather than save costs. Resource constraints are even more noticeable in Asia than in other regions, with a ...


    pub_type: 杂志文章


    authors: Yang BM

    更新日期:2009-01-01 00:00:00

  • Correction to: Weight Reduction and Pioglitazone are Cost-Effective for the Treatment of Non-alcoholic Fatty Liver Disease in Thailand.

    abstract::Weight Reduction is Cost-Effective for the Treatment of Non-alcoholic Fatty Liver Disease in Thailand. ...


    pub_type: 已发布勘误


    authors: Chongmelaxme B,Phisalprapa P,Manthaisong R,Dilokthornsakul P,Chaiyakunapruk N

    更新日期:2019-02-01 00:00:00

  • What's good and bad about contraceptive products?: a best-worst attribute experiment comparing the values of women consumers and GPs.

    abstract:BACKGROUND:In the past decade, the range of contraceptives available has increased dramatically. There are limited data on the factors that determine women's choices on contraceptive alternatives or what factors providers consider most important when recommending contraceptive products to women. OBJECTIVES:Our objecti...


    pub_type: 杂志文章


    authors: Knox SA,Viney RC,Street DJ,Haas MR,Fiebig DG,Weisberg E,Bateson D

    更新日期:2012-12-01 00:00:00

  • A Case Study Examining the Usefulness of Cure Modelling for the Prediction of Survival Based on Data Maturity.

    abstract:INTRODUCTION:Mixture modelling is increasingly being considered where a potential cure leads to a long life. Traditional methods use relative survival models for frail populations or cure models that have improper survival functions with theoretical infinite lifespans. Additionally, much of the work uses population dat...


    pub_type: 杂志文章


    authors: Grant TS,Burns D,Kiff C,Lee D

    更新日期:2020-04-01 00:00:00

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    abstract::This paper analyses the 32 technology appraisals completed by the National Institute for Clinical Excellence (NICE) in the UK from its establishment to the end of January 2002. It looks at why technologies have been rejected, what has happened to products reviewed at launch, evidence of rationing on cost-effectiveness...


    pub_type: 杂志文章


    authors: Towse A,Pritchard C

    更新日期:2002-01-01 00:00:00

  • Adherence to guidelines for community-acquired pneumonia: does it decrease cost of care?

    abstract::Community-acquired pneumonia (CAP) is a common diagnosis and care of CAP is responsible for significant healthcare expenditures, the majority of which are for patients who require hospitalisation. Studies have shown that significant variation exists among institutions with respect to antibacterial costs and length of ...


    pub_type: 杂志文章,评审


    authors: Brown PD

    更新日期:2004-01-01 00:00:00

  • The changing environment for US pharmaceuticals.

    abstract::Health reform is currently the predominant health policy issue in the US. It carries profound implications for the pharmaceutical field, including the possibility of price controls that could stifle pharmaceutical research. While policy makers are contemplating alternative approaches to reform, the marketplace for pha...


    pub_type: 杂志文章


    authors: Meyer PR

    更新日期:1994-01-01 00:00:00

  • Costs and effects associated with a community pharmacy-based smoking-cessation programme.

    abstract:OBJECTIVE:The aim of the study was to determine the costs and effects associated with a community pharmacy-based smoking-cessation programme in Northern Ireland, using the perspective of the payer in the main analysis. DESIGN AND SETTING:Data from a pilot study conducted in 2 community pharmacies in Northern Ireland w...


    pub_type: 杂志文章


    authors: Crealey GE,McElnay JC,Maguire TA,O'Neill C

    更新日期:1998-09-01 00:00:00

  • Estimating the cost effectiveness of atovaquone versus intravenous pentamidine in the treatment of mild-to-moderate Pneumocystis carinii pneumonia.

    abstract::Pneumocystis carinii pneumonia (PCP) is the most common severe opportunistic infection, and one of the most costly, among people with AIDS. Over 50% of patients experience toxic effects of the major anti-PCP medications- cotrimoxazole (trimethoprim-sulfamethoxazole) and pentamidine. Recently, the US Food and Drug Admi...


    pub_type: 临床试验,杂志文章


    authors: Zarkin GA,Bala MV,Wood LL,Bennett CL,Simpson K,Dohn MN

    更新日期:1996-06-01 00:00:00

  • Pharmacoeconomics of nonsteroidal anti-inflammatory drugs (NSAIDs).

    abstract::Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used for the relief of the symptoms of osteoarthritis (OA), rheumatoid arthritis (RA), sprains and strains, sports injuries and menstrual disorders, and have a small role in the management of patent ductus arteriosus in the neonate. In patients with RA, symptom...


    pub_type: 杂志文章,评审


    authors: Wynne HA,Campbell M

    更新日期:1993-02-01 00:00:00

  • Alcoholism. The cost of illness in the Federal Republic of Germany.

    abstract::The purpose of this study was to estimate the direct and indirect costs of alcoholism in the Federal Republic of Germany. Direct costs comprised treatment costs, while indirect costs consisted mainly of costs incurred as a result of work time lost, as well as costs related to premature retirement and premature mortali...


    pub_type: 杂志文章


    authors: Brecht JG,Poldrugo F,Schädlich PK

    更新日期:1996-11-01 00:00:00

  • Evaluation of the cost effectiveness of escitalopram versus venlafaxine XR in major depressive disorder.

    abstract:AIM:To assess the relative cost effectiveness of escitalopram compared with venlafaxine XR in patients with major depressive disorder (MDD). METHODS:An economic evaluation was conducted alongside a double-blind, multinational, randomised clinical trial and examined the costs and quality of life of 251 patients taking ...


    pub_type: 临床试验,杂志文章,随机对照试验


    authors: Fernandez JL,Montgomery S,Francois C

    更新日期:2005-01-01 00:00:00

  • Drug utilisation in preterm and term neonates.

    abstract::Drug utilisation in term and preterm neonates (i.e. less than 28 days of age) has been investigated prospectively in 4 clinical studies during the past 10 years. 3880 neonates with a mean gestational age of 34.5 weeks (corresponding birthweight 2280g) were enrolled in these studies. An overview indicates a high prev...


    pub_type: 杂志文章,评审


    authors: Gortner L

    更新日期:1993-12-01 00:00:00

  • Economic and developmental considerations for pharmacogenomic technology.

    abstract::The pharmaceutical industry's core business is the innovation, development and marketing of new drugs. Pharmacogenetic (PG) testing and technology has the potential to increase a drug's value in many ways. A critical issue for the industry is whether products in development should be teamed with genetic tests that cou...


    pub_type: 杂志文章


    authors: Vernon JA,Johnson SJ,Hughen WK,Trujillo A

    更新日期:2006-01-01 00:00:00

  • Parent-proxy EQ-5D ratings of children with attention-deficit hyperactivity disorder in the US and the UK.

    abstract:BACKGROUND:The symptoms of attention-deficit hyperactivity disorder (ADHD) are associated with impairment in multiple domains of health-related quality of life (HR-QOL). HR-QOL of children with ADHD has been assessed by relatively long multidimensional questionnaires. A review of the literature found no studies using t...


    pub_type: 杂志文章


    authors: Matza LS,Secnik K,Mannix S,Sallee FR

    更新日期:2005-01-01 00:00:00

  • Introduction to the pharmacoeconomics of herbal medicines.

    abstract::This article explores the need to perform pharmacoeconomic evaluations of herbal medicines and assesses the extent to which this approach has been applied so far to these products. There seems to be no compelling need for pharmacoeconomic analyses of herbal over-the-counter medicines, but such analyses are certainly w...


    pub_type: 杂志文章


    authors: De Smet PA,Bonsel G,Van der Kuy A,Hekster YA,Pronk MH,Brorens MJ,Lockefeer JH,Nuijten MJ

    更新日期:2000-07-01 00:00:00

  • Pharmacoeconomic analysis of amphotericin B lipid complex versus liposomal amphotericin B in the treatment of fungal infections.

    abstract:BACKGROUND:Potential differences in toxicity, potency and acquisition price among the liposomal amphotericin B formulations makes it unclear which agent is less costly when total resource consumption and treatment-associated costs are considered. DESIGN:A retrospective cost-minimisation analysis in 51 patients was per...


    pub_type: 杂志文章


    authors: Kuti JL,Kotapati S,Williams P,Capitano B,Nightingale CH,Nicolau DP

    更新日期:2004-01-01 00:00:00

  • A model to assess the cost effectiveness of statins in achieving the UK National Service Framework target cholesterol levels.

    abstract:BACKGROUND:Coronary heart disease (CHD) is a public health priority in the UK. The National Service Framework (NSF) has set standards for the prevention, diagnosis and treatment of CHD, which include the use of cholesterol-lowering agents aimed at achieving targets of blood total cholesterol (TC) < 5.0 mmol/L and low d...


    pub_type: 杂志文章


    authors: Wilson K,Marriott J,Fuller S,Lacey L,Gillen D

    更新日期:2003-01-01 00:00:00

  • 30 years of pharmaceutical cost-utility analyses: growth, diversity and methodological improvement.

    abstract::To review and critically evaluate published cost-utility analyses (CUAs) pertaining to pharmaceuticals for the past 3 decades. We examined data from the Tufts Medical Center Cost-Effectiveness Analysis Registry (, which contains detailed information on English-language CUAs and their ratios (in $US...


    pub_type: 杂志文章


    authors: Neumann PJ,Fang CH,Cohen JT

    更新日期:2009-01-01 00:00:00

  • Assessing the economic value of a new antidepressant. A willingness-to-pay approach.

    abstract::Using the method of willingness to pay (WTP), this study assesses the value of a new antidepressant, moclobemide, relative to that of tricyclic antidepressants (TCAs), which have equivalent efficacy but less favourable adverse effect profiles. From a published meta-analysis of controlled clinical trials, we identified...


    pub_type: 临床试验,杂志文章


    authors: O'Brien BJ,Novosel S,Torrance G,Streiner D

    更新日期:1995-07-01 00:00:00

  • Onychomycosis: health-related quality of life considerations.

    abstract::The symptoms of onychomycosis and their impact on personal appearance are important determinants of patients' perceptions of their own health. The effect of onychomycosis is greater on psychosocial than physical functioning and is directly related to the extent of nail involvement. This review identified a number of d...


    pub_type: 杂志文章,评审


    authors: Shaw JW,Joish VN,Coons SJ

    更新日期:2002-01-01 00:00:00