OBJECTIVES: To generate evidence of value of anesthetics.

METHODS: Systematically searched Cochrane Library, MEDLINE, EMBASE, CNKI, VIP and WanFang for randomized controlled trials(RCTs) of remifentanil versus Fentanyl(combined with the same anesthetics) in total intravenous anesthesia in adult surgery. Included primary Chinese&English full literatures published during January 2007-March 2018. Identified RCTs for thoracoabdominal, orthopedic, interventional and minimally-invasive surgeries to perform meta-analysis. Effectiveness was measured by emergence&extubation time, hemodynamic change and postoperative adverse reaction(ADR) rate. Cost was calculated based on dosage and IQVIA price of anesthetics. Expenditures for longer ICU stay and ADR treatment were calculated based the average ICU expenditure and treatment guidelines. Comparative cost-effectiveness was calculated. Single factor sensitivity analysis was performed based on the change of length of surgery, effectiveness and price of remifentanil.

RESULTS: Compared remifentanil with fentanyl, 13.98RMB is needed to reduce 1 minute emergency time in thoracoabdominal surgery(23 RCTs involving 1280 patients). Extubation time and length of ICU stay would shorten 1.71 and 4.23 minutes, systolic and diastolic pressure (SBP and DBP) and heart rate would be stabilized with 1.12 and 0.42 mmHg, and 0.24 times per minute. Respiratory depression, drowsiness, cutaneous intolerance and light anesthesia incidence would decline 15.49%, 33.33%, 26.67% and 33.33%. 38.49RMB is needed to reduce 1 minute emergency time in orthopedics surgery(6 RCTs involving 1198 patients). Extubation time would shorten 3.40 minutes, propofol dosage would reduce 15.53mg, SBP and DBP would be stabilized with 12.72 and 6.94mmHg, nausea incidence would decline 36.46%. 9.45RMB is needed to reduce 1 minute of emergency time in interventional minimally invasive surgery(47 RCTs involving 4691 patients). Extubation time would reduce 1.37 minutes, propofol dosage would reduce 17.26mg, DBP would be stabilized with 1.53mmHg, nausea incidence would decline 4.9%. In sensitivity analysis, the evaluation results would not been affected.

CONCLUSIONS: The cost-effectiveness of remifentanil versus fentanyl in adult surgery is acceptable.