Cost-effectiveness Analysis On Addition Of A New Sedative And Analgesic Drug Dexmedetomidine Hydrochloride To General Anesthesia Program

OBJECTIVESA cost-effectiveness analysis on addition of a new sedative and analgesic drug dexmedetomidine hydrochloride to general anesthesia program by a way of Pharmacoeconomic evaluation, which given a reference for choosing a safe, effective and economic anesthesia program in clinic.METHODS1. Source To Select the patients who are electively undering lobectomy and (40 cases), laparoscopic surgery (including laparoscopic simple cholecystectomy, laparoscopic resection attachments Surgery, laparoscopic surgery excavation of 34 cases), and they are in a large comprehensive 3 armour hospital from December,2009 to November, 2010.2,Randomized dividing group The selected lobectomy (operating time>2h) and laparoscopic surgery (operation time<2h) patients are respectively divided into the control group (normal saline group, C1, C2 group) and experimental group (dexmedetomidine hydrochloride group, D2, D1 group).3,anesthesia plan:Dexmedetomidine group (D1, D2 group):Given dexmedetomidine hydrochloride-midazolam-fentanyl-cis-atracurium amine-propofol.normal saline group (C1, C2 group):Given normal saline-midazolam-fentanyl-cis-atracurium amine-propofol.Before general anesthesia induction, Intravenous infusion of dexmedetomidine hydrochloride and normal saline with loading dose of 0.6μg·kg-1 (10min within the pumping end) respectively. A fter general anesthesia induction, continue to give a maintenance dose of 0.5μg·kg-1·h-1.4. data collection Record respectively the time which are associated with anesthesia respectively, including surgery time, anesthesia time to take the operating room, Directional power recovery time, recovery time, extubation time, the time of occupied postoperative PACU (ICU), and the dosage of anesthetic drugs. Recorded the patients of hemodynamic parameters at each time point, including before induction of anesthesia (T1), after induction of anesthesia (T2), before intubation (T3), after intubation (T4), the beginning of operation (T5), surgery began to 5min (T6), surgery began to 10min (T7), Surgery began to 30min (T8), the beginning of operation 1h (T9), the end of surgery (T10), the awakening time (T11), after extubation (T12), after surgery 1h(T13), after surgery 12h(T14), after surgery 24h(T15), and incision in the situation, with or without anesthesia-related complications occurred. Also record the anesthesia satisfaction score and collect the cost which is related anesthesia during the perioperative in patients.5. Cost-effectiveness analysis Finally, From the perspective of health care providers, considering all patients paied in perioperative anesthesia as cost, and patient satisfaction as the performance metrics, calculated respectively to get the cost-effectiveness ratio and incremental cost effectiveness ratio in each group. Finally to single factor sensitivity analysis on the results.RESULTS1,Comparison of general date Two surgery types of patients has no significant difference in age, gender, ASA classification and type of surgery. 2,Comparison of effect index(1) Dosage of propofol in D1 group, D2 group is significantly lower than C1 group, C2 group respectively. (Dl:701.90±327.12mg, 701.90±327.12mg, C1:923.10±215.15mg; D2:296.11±67.84; C2: 374.69±120.66).(2)Comparing with C1 group, C2 group, D1 group, D2 group have a higher total of perioperative anesthesia, respectively. (D1: 3695.51±436.47, Cl:3446.76±274.58,P<0.05; D2:2114.35±141.62, C2:1960.56±143.52; P<0.05).(3) C1 group, D1 group and C1 group, D1 group were comared respectively. There are no significant difference between postoperative pain score, and anesthetic failures or serious anesthesia adverse effect have not been found in four groups. Moreover, there has statistical significance in difference of the incidence rate of adverse effect between C1, Dland C1, D2 (including PONV, bradycardia, hypotension, hypertension, restlessness and so on) (C1:40%, D1:10%, P=0.028; C2:37.5%, D2:5.6%, P=0.021). The satisfaction rate of patients in both groups had significant differences (C1 group:65%, D1 group:95%, P=0.018; C2 group:50%, D2 group:88.9%, P= 0.07).3,Pharmacoeconomic evaluation To evaluate by the way of cost-effectiveness analysis in this study. The results of Cost-effectiveness ratio (C1 group 53.03, D1 group:38.90, C2 group:39.21, D2 Group:23.78) showed that addition of dexmedetomidine hydrochloride to anesthesia program were cost effectiveness. Then the results of sensitivity analysis showed that cost-effectiveness ratio were stable with the change of costs or effects. CONCLUSIONFrom the perspective of health care providers, the anesthesia program addition to a new sedative analgesic drug dexmedetomi-dine hydrochloride, although was more expensive, but it could be significantly improved patient satisfaction after surgery, and significantly reduce the amount of propofol and the need Handling adverse reaction rates. It also could reduce the stress response during intubation and maintain hemodynamic stability. From the results of cost-effectiveness analysis and ICER, it displayed that the anesthesia program addition to dexmedetomidine hydrochloride was cost-effective.