A Cost Analysis of the Laryngeal Mask Airway for Elective Surgery in Adult Outpatients

Abstract

Laryngeal mask airways (LMA) no doubt represent one of the most popular innovations in anesthesiology during the past two decades. However, the cost of a single LMA, approximately $200, has led some to question whether its use for uncomplicated anesdietics is cost-effective. Macario et al. carefully analyzed the independent cost variables for use of the LMA compared with three common airway management techniques during administration of a standard anesthetic.

The two factors most important in determining the cost-effectiveness were case length and the LMA reuse rate. The rule of “40s” applied: if the LMA was reused 40 times, it became the cost-effective airway choice for anesthetics of 40 min duration or more. The longer the case, the more cost-effective the LMA compared with endotracheal intubation with either spontaneous or controlled ventilation, presumably because of the additional cost of the greater amount of inhalation anesdietics required for the patient to tolerate the endotracheal tube. Moreover, as the LMA reuse rate increased, the point (case duration) at which it became cost-effective was reduced.

For shorter anesdietics, use of the face mask was most cost-effective. However, no “inconvenience costs” to the anesthesiologist were included in their estimates and certainly most anesthesiologists value not having at least one hand firmly planted on the face mask and jaw. Other factors involving costs to the patient, but not to the practitioner, and not included in the analysis were those of succinylcholine myalgias and risk of sore throat. Both of these intangibles also favor the LMA. This analysis was carefully performed and represents what will probably become an increasingly common approach in quantifying risks, benefits, and costs of new technology.