PRESENTATION #4 Clinical Research | Fundamentals of Anesthesiology
PHARMACO-ECONOMICS OF INTRAVENOUS VS ORAL ACETAMINOPHEN IN ERAS PROTOCOLS: COST EFFECTIVE OPPORTUNITIES TO IMPROVE PATIENTS’ ANALGESIA
Wesley Stowe, MD, Lauren Macke, MD, John Helmstetter MD and Brett Arron, MD
LSU Health New Orleans
Presenter: Wesley Stowe, MD
LSU Health New Orleans
Physicians control the bulk of perioperative medications that are prescribed to patients. Nuances in the prescription of medications influence the distribution of capital throughout the healthcare universe. Acetaminophen’s analgesic properties are intended to reduce opioid use in ERAS protocols.
In January 2020, the price of IV acetaminophen increased 10% to approximately $40 per dose. Hospitals charge patients about three time their cost, about $130 for one dose. Oral acetaminophen 500 mg tablets cost $0.03 each. Oral acetaminophen 1000 mg every 6 hours for 4 – 6 doses given preoperatively achieves equipotent or higher CSF levels as one Intraoperative dose of intravenous acetaminophen, at 1% of the cost and 3% of the patient charge.
A hospital system with 50,000 major surgical procedures faces a cost differential of $2 million vs $18,000 for equipotent patient CSF levels of IV vs oral acetaminophen. With a return on investment ratio (ROI) of 20:1, hospitals have to find $39.6 million dollars of new income to replace the cost differential to the hospitals’ balance sheet. Total charges to every 50K patients are $6,500,000 for the benefit they could have been achieved with oral acetaminophen for $18,000.
Extrapolating the data set to 40 million annual anesthetics, the acquisition cost goes up to $1.6 billion dollars for IV acetaminophen compared to $14.4 million for the equipotent oral acetaminophen. Patients’ charges are $6.4 billion dollars. ROI expense: $32.7 billion
Discussion: Nationally perioperative acetaminophen administration represents approximately $53,000 of costs and $1.73 million dollars of patients’ charges attributable to each practicing anesthesiologist (30K). Physician anesthesiologists are uniquely positioned to best shepard our patients’ and hospitals’ valuable resources. Re-engineering and monitoring pre-operative systems can generate substantial cost efficiencies that should be shared with anesthesiology groups. Our patients and hospitals deserve our best choices and thoughtful perioperative system designs.