The economic burden of anesthetic-related adverse events: a systematic review and empirical analysis

Background: While extensive evidence is available on the adverse events (AEs) related to agents used to perform general anesthesia and procedural sedation from a clinical standpoint, much less is known about their economic impact on healthcare systems. This study aims to fill this gap combining an umbrella review of systematic reviews and an economic empirical analysis. Methods: We performed an umbrella review of systematic reviews and meta-analyses identified through PubMed and Web of Science searches conducted through September 2024 to map the anesthetic agents for which quantitative data exist on the incidence of AEs in adult patients undergoing procedural sedation or general anesthesia in developed countries. Data were used to conduct a gross costing estimate of the economic burden of these agents, using the Italian healthcare system as a case study. This analysis was complemented by a systematic literature review aimed at identifying cost estimates of anesthetic-related complications. Results: We included 168 systematic reviews and meta-analyses in the umbrella review. The gross costing estimation suggested that intravenous anesthetics (specifically propofol, etomidate, ketamine) and dexmedetomidine are the agents with the highest complication costs to the Italian healthcare system. Cognitive disorders and delirium were the most expensive complications described in the 22 publications identified in the systematic literature review which focused on costs; however, there was major heterogeneity in cost estimates across countries. Moreover, the lack of data uniformity in the estimation methods impaired further comparisons across anesthetic agents. Conclusion: Anesthetic-related complications costs are a crucial element that, together with clinical effectiveness, should drive adoption and reimbursement decisions. While this study identifies key AEs and estimates their costs, a major research gap still exists. Future research should improve the way such costs are estimated since direct costs of drugs and supplies to manage complications are by far lower than costs associated with nurses and physician labor, postponement of other surgical procedures, and intensive care unit admissions for monitoring or treating complications. Micro costing analyses are needed to improve the evidence available in this area.