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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
A cost-benefit analysis of the ENIGMA trial
Anesthesiology, Volume 115, No. 2, Year 2011
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Description
Background: The ENIGMA trial was a prospective, randomized, multicenter study that evaluated the clinical consequences of including N2O in general anesthesia. Patients who were given a N2O-free anesthetic when undergoing major surgery for which the expected hospital stay was at least 3 days had lower rates of some postoperative complications. This suggests that, despite a higher consumption of potent inhalational agent, there could be a financial benefit when N2O is avoided in such settings. Methods: A retrospective cost analysis of the 2,050 patients recruited to the ENIGMA trial was performed. We measured costs from the perspective of an implementing hospital. Direct health care costs include the costs for maintaining anesthesia, daily medications, hospitalization, and complications. The primary outcome was the net financial savings from avoiding N2O in major noncardiac surgery. Comparisons between groups were analyzed using Student t test and bootstrap Methods. Sensitivity analyses were also performed. Results: Rates of some serious complications were higher in the N2O group. Total costs in the N2O group were $16,203 and in the N2O-free group $13,837, mean difference of $2,366 (95% CI: 841-3,891); P = 0.002. All sensitivity analyses retained a significant difference in favor of the N2O-free group (all P ≤ 0.005). Conclusions: Despite N2O reducing the consumption of more expensive potent inhalational agent, there were marked additional costs associated with its use in adult patients undergoing major surgery because of an increased rate of complications. There is no cogent argument to continue using N2O on the basis that it is an inexpensive drug. Copyright © 2011, the American Society of Anesthesiologists, Inc.
Authors & Co-Authors
Graham, Alison M.
Australia, Melbourne
The Alfred
Myles, Paul S.
Australia, Melbourne
The Alfred
Australia, Clayton
Monash University
Australia, Parkes
Australian Government
Leslie, Kate E.
Australia, Melbourne
Royal Melbourne Hospital
Australia, Melbourne
University of Melbourne
Chan, Matthew Tak Vai
Hong Kong
Prince of Wales Hospital Hong Kong
Paech, Michael J.
Australia, Perth
University of Western Australia, School of Medicine and Pharmacology
Australia, Perth
King Edward Memorial Hospital for Women
Peyton, Philip
Australia, Melbourne
Austin Hospital
El-Dawlatly, Abdelazeem Ali
Saudi Arabia, Riyadh
College of Medicine
Statistics
Citations: 26
Authors: 7
Affiliations: 10
Identifiers
Doi:
10.1097/ALN.0b013e31821f659c
ISSN:
00033022
e-ISSN:
15281175
Research Areas
Health System And Policy
Study Design
Cohort Study