Vergleichende pharmakoökonomische Evaluation zweier Anästhesieverfahren bei Operationen im Bereich der Hals-, Nasen- und Ohrenheilkunde. Eine Kosten-Effektivitätsanalyse am Beispiel einer Desfluranbetonten versus einer Remifentanilbetonten Narkosetechnik

The growing area of conflicts between medical standards and economic conditions has also essential influence on the choice of the technique of anaesthesia and the resulting direct and indirect costs. Newer anaesthetics often offer higher patient-comfort due to fewer rate of site effects, quicker awakening from anaesthesia with fast recovery of cognitive functions and good controllability of the drugs, but which are normally also much more expensive than conventional anaesthetics. Within a cost-effectiveness analysis can be verified whether the difference of costs of two different procedures with the same indication is justified by a therapeutic benefit and/or reduction of costs. In this study both possible techniques of anaesthesia with desflurane and remifentanil compared according to defined indicators of quality (patient satisfaction, controllability of anaesthesia, recovery and unwanted events during and following surgery) and thereby connected costs: using a high concentration of desflurane with few opioid versus a remifentanil based and desflurane supplemented anaesthesia. Both techniques of anaesthesia showed good controllability in ear, nose and throat surgery and did not reveal any significant differences of intra- and postoperative side effects. Concerning the costs desflurane based anaesthesia represents the best economic option. But being treated with a remifentanil based technique, patients were significantly earlier to extubate, arrives earlier at the PACU and finally at the ward. In a surgical departement like ENT-surgery having great numbers of short term operations the resulting time savings could offer the opportunity of an additional surgery per day, thereby providing the possibility to outvalue the higher drug associated costs.