Comparison of propofol and ketamine-midazolam for cystoscopy: A randomized trial with clinical economic analyses

Objectives: We compared the duration and quality of recovery and the cost of anesthesia between propofol and ketamine-midazolam for cystoscopy as a model to explain the decision in a tertiary care, government hospital in a developing country. Methods: This is a randomized, double-blind trial. Forty- eight male patients were randomized to receive propofol or ketamine- midazolam. Recovery was evaluated by a series of clinical tests, modified P deletion and Stroop color tests, and the time to discharge. Patients' pain score, satisfaction score and willingness to pay were evaluated. Direct medical cost from the Perspective of health care provider was calculated. Cost-effectiveness and cost-benefit analyses Were done. Results: Although clinical recovery was not different, both psychomotor tests showed that patients in the propofol group recovered significantly faster. They were able to stand, walk and meet the discharge criteria faster (P < 0.05) and had fewer side effects. However, pain and satisfaction scores and the willingness to pay were not different. For each patient, propofol cost 12.31 US dollars more but the patient recovered 44.8 min faster than with ketamine-midazolam. When this faster recovery time was changed into monetary units, propofol did not save money but cost 9.03 US dollars per patient more than Ketamine- midazolam. Patients' expectation and salary scales can affect decision- making.