Link of Video Abstract: https://youtu.be/KigXgHWz0JU
Background: The common neuroaesthetics used for neurosurgery was inhalation of Sevoflurane and the newest, by continuous infusion of propofol called Total Intravenous Anesthetic (TIVA). Anesthesia procedures are one of the biggest healthcare expenditures in hospitals. Thus, finding the most effective and efficient anesthetic technique but in the same time can maintain patient safety is important. This literature review compares a cost-effective Sevoflurane and propofol TIVA analysis in craniotomy surgery.
Methods: This literature review was carried out by searching studies in three online databases consisted of PubMed, the Cochrane Library, and Google Scholar using the keywords "sevoflurane inhalation anesthetic", "propofol total intravenous anesthesia", "TIVA”, “craniotomy’, "cost-effective analysis", and “pharmacoeconomic”. Appropriate studies were then carried out through a narrative synthesis analysis.
Results: The assessment of cost-effective analysis in anesthesia is broadly divided into fixed commodities and various commodities. The analysis found the highest use of costs in the TIVA group and the lowest in the isoflurane inhalation group. The high cost in the TIVA group was caused by propofol being the most expensive compared to other inhalation agents such as isoflurane and Sevoflurane. Based on the average intraoperative anesthetic cost, it was also found that the anesthetic cost per patient was Rp. 957,870,- for the TIVA propofol group and Rp. 1,318,130,- for the sevoflurane group. Sevoflurane use for induction and maintenance of anesthesia resulted in a further modest decrease in costs (especially if fresh gas flow was reduced early), primarily through less drug waste.
Conclusion: The cost-effective analysis showed that Sevoflurane was less expensive than propofol. Yet, in terms of pharmacoeconomics, using TIVA propofol results in much fewer PONV episodes, unplanned hospital admissions, and patient lengths of stay, all of which improve pharmacoeconomic benefits.