ROUTINE BIS MONITORING ALLOWS TO CUT DOWN THE COSTS OF VOLATILE ANAESTHETICS
A. Andruszak - Kot, A. Bzowska, P. Dyl, M. Borun, T. Napiorkowski, M. Symonides The Maria Sklodowska Curie Memorial Cancer Centre and Institute of Oncology – Warsaw, POLAND

BACKGROUND AND GOAL OF STUDY: 
Volatile anaesthetics are a costly element of anesthesia, even with low flow, while monitoring anesthesia depth (e.g. bispectral index) is becoming more common. The aim of this analysis was to if bispectral index monitoring allows to decrease the use of volatile anesthestics and limit costs. 

MATERIALS AND METHODS: 
We calculated the average cost of volatile anesthetics per procedure in consecutive general anaesthesia cases performed in a tertiary reference hospital over a period of three years. The types, average duration and extent of procedures were similar over the years. In 2014 BIS was used in few cases, In 2015 BIS monitoring was as routine approach in all general anaesthesia cases for 6 months; in 2016 BIS was used for all general anesthesia cases. The costs of desflurane and sevoflurane were divided by the number volatile anesthesia cases performed by the same team of physiscians. Routine maintenance includes low-flow of 1.5 litres maximal fresh gas flow. No significant changes in anaesthesia techniques were observed in those years. 

RESULTS AND DISCUSSION:
In 2014 (no BIS monitoring; approx. 7100 volatile anesthesia procedures) 578 sevoflurane bottles (97 Euro per bottle) and 283 desflurane bottles (113 Euro per bottle) were used; total cost of volatile anaesthesia was approx. 88 427 Euro (i.e. 12.45 Euro on average per procedure) In 2015 (6 months of BIS monitoring; approx. 8600 volatile anesthesia procedures) 621 sevoflurane bottles (97 Euro per bottle) and 333 desflurane bottles (113 Euro per bottle) were used; total cost of volatile anesthesia was approx. 98 520 Euro (i.e. 11.45 Euro on average per procedure) In 2016 (all procedures BIS monitored; 9400 volatile anesthesia procedures) 578 sevoflurane bottles (97 Euro per bottle) and 299 desflurane bottles (116 Euro per bottle) were used; total cost of anesthesia approx. 89 767 Euro (i.e. 9.55 Euro on average per procedure) 

CONCLUSIONS:
We conclude that the routine use of BIS monitoring has allowed to decrease the average cost of volatile anaesthetic used per procedure to 76% of initial expenditure, thus allowing to save approximately 27 376 Euro per annum. This does not cover the costs of BIS electrodes, but in view of the prices on our market it allows for a return of approximately 30% of their cost.





03 / Routine BIS monitoring allows to cut down the costs of volatile anaesthetics