A method of costing anaesthetic practice

Abstract

Summary This paper identifies the main factors involved in the cost of elective general anaesthetic practice. The costs of anaesthesia were divided into overheads and running costs, which are sensitive to the duration of anaesthesia, and fixed costs which are incurred by each patient but are not sensitive to the duration of anaesthesia. The overhead costs consisted of salaries, capital equipment and maintenance costs. The overhead cost of a consultant anaesthetist combined with a technical assistant's salary, monitoring equipment and anaesthetic machine was estimated at £45.05.h ‐1 (using 1993 salary scales and prices). The fixed costs of pre‐operative assessment and nursing care in recovery were the same for all patients, £20.60 per patient. For the majority of anaesthetics the combined cost of the anaesthetist, overheads and postoperative care was about 70% of the total cost, the remainder being the running costs which included drugs, anaesthetic gases, vapours, intravenous fluids, sterile equipment and other disposable items. Four sample anaesthetics were costed in two ways: both methods used the same overhead and fixed cost per patient but one added the cost of all the individual drugs and consumables used, whereas the other grouped these together using a charge sheet which can be computerised and used prospectively to cost anaesthesia. There was close agreement between the costs derived with the two methods. The cost of a 30min delay in the start of an operating session was £27.30 (anaesthetist, assistant and nurse salary (£9.50.h ‐1 )) which is more than the cost of 2h of propofol infusion anaesthesia. There was a difference between the estimated costs of an anaesthetic as calculated by management and by our analysis. The cost apportioned by management for assistants and recovery nurses’salaries was nearly £50.h ‐1 and the cost for anaesthetic equipment maintenance and anaesthetic capital costs was nearly £20.h ‐1 . These management figures were considerably greater than our estimates of £19.14.h ‐1 and £3.20.h ‐1 respectively. We advocate the use of a charge sheet for providing an easy estimate of anaesthetic cost rather than relying on management estimates.