Cost-effectiveness analysis of total intravenous vs. inhalation anaesthesia among adults aged ≥ 50 y undergoing major non-cardiac surgery.

Abstract

Total intravenous and inhalational anaesthesia are used widely to maintain general anaesthesia for major non-cardiac surgery, yet their comparative cost-effectiveness remains uncertain. The VITAL trial evaluated clinical outcomes, showing no difference in days alive and at home at 30 days. We conducted an economic evaluation alongside VITAL to determine whether total intravenous anaesthesia offers an economic advantage within the UK NHS. A within-trial economic evaluation was conducted from the NHS and personal social services perspective over a 6-month time horizon. Resource use was collected from trial records and questionnaires, and health-related quality of life was measured using EuroQol five-dimension five-level instrument at baseline, discharge, 30 days and 6 months. Costs were evaluated using national sources and quality-adjusted life years were calculated using the area under the curve approach. Incremental cost-effectiveness ratios were estimated using imputed datasets, with uncertainty explored through bootstrapping and the probability of cost-effectiveness illustrated using a cost-effectiveness acceptability curve across a range of willingness-to-pay thresholds. A total of 2507 patients were allocated randomly: 1253 (50%) received total intravenous anaesthesia; and 1254 (50%) inhalational anaesthesia. Mean costs and quality-adjusted life years were similar across groups. Incremental cost was -£145 (95%CI -£1510-£1220) and incremental quality-adjusted life years -0.001 (95%CI -0.008-0.005). Total intravenous anaesthesia showed a 56-57% probability of cost-effectiveness at standard willingness-to-pay thresholds. Sensitivity analyses, including complete-case and societal-perspective models, yielded consistent findings of equivalence. Total intravenous and inhalational anaesthesia show comparable cost-effectiveness for adults aged ≥ 50 y undergoing major non-cardiac surgery. Given clinical equipoise and equivalent economic outcomes, anaesthetic choice should continue to be guided by patient factors, clinician expertise and organisational context. Further research may be justified given the large population undergoing major surgery. Researchers compared two common ways of keeping people asleep during major surgery: total intravenous anaesthesia, which uses medicines given through a drip; and inhalational anaesthesia, which uses anaesthetic gases. They followed more than 2500 patients aged 50 years and older and measured both the costs of care and the patients' quality of life for six months after surgery. Both types of anaesthesia are used widely, but it is not clear whether one provides better value for money. The researchers wanted to find out if one method costs less or leads to better recovery and quality of life for patients. The researchers found that the two types of anaesthesia performed very similarly. Patients had similar quality of life and recovery, and the costs to the NHS were almost the same. Neither approach showed a clear advantage over the other. This means that doctors can continue to choose the type of anaesthesia based on the patient's needs, their own experience and local hospital practices, rather than cost alone.