(Part 1) Economic aspects of concentration-oriented anaesthesia: intravenous agents

Total intravenous anaesthesia (TIVA) has become more popular because of its ease-of-use and because there are fewer side effects. Nevertheless, this technique is more expensive because it uses new drugs such as propofol and remifentanil. Economic evaluation shows that its cost is up to four times greater than that of inhalational anaesthesia. Target-controlled anaesthesia is even more expensive, being up to twice the price of manually controlled infusion of propofol. Drug wastage is a major origin of expenditure. The gain in indirect costs because of the reduction of side effects with TIVA does not decrease its total cost compared with other techniques for anaesthesia. Bispectral index monitoring does not seem to have any effect on cost reduction, but further studies are needed.