Clinical and Cost-Effectiveness and Budget Impact of Routine Use of Bispectral Index Monitors In Theatres.

A cost utility analysis and budget impact (BI) were developed using a decision model to compare the incremental outcomes and costs of monitoring the depth of anaesthesia with BIS monitors compared with using clinical signs, electrocardiography (ECG) and other devices (standard clinical monitoring) over a five-year period. The health outcomes included are utility values associated with adverse events avoided. An NHS perspective was adopted and costs and outcomes were discounted at 3.5% a year. Sensitivity analyses explored uncertainty in the model. In the base-case, a cohort of 100,000 patients aged 15 and older undergoing surgery lasting more than 2 hours with general anaesthetic was adopted. Subgroup analysis was conducted for an elderly patient group. Bispectral Index (BIS) monitoring systems monitor spontaneous electroencephalography, track sedative drug effects and help guide anaesthetic administration. At least one review of clinical evidence concludes that such monitoring presents a strong opportunity for cost reduction on anaesthesia due to demonstrated potential to reduce adverse events including cases of posttraumatic stress disorder (PTSD), postoperative nausea and vomiting (PONV), postoperative cognitive dysfunction (POCD) and postoperative delirium (POD) compared with monitoring clinical signs only. It may also reduce recovery time in the post-anaesthesia care unit and use of anaesthesia. However, the costeffectiveness of monitors is uncertain.