Cost of Common Anesthesia Medications
Although anesthetic drugs represent only a small fraction of total operating room (OR) costs, far less than staffing, equipment, or OR time, specific drug choices can meaningfully affect per-case and cumulative institutional spending. Wholesale Acquisition Cost (WAC) or the Centers for Medicare & Medicaid Services (CMS) Average Sales Price (ASP) are typically used as benchmarks of the cost to medical facilities for anesthesia medications, spanning induction agents, inhalational anesthesia, sedatives, analgesics, and more.
Cost is typically not a significant factor when selecting anesthesia medications for intravenous induction, given the comparable, relatively low prices. Propofol, the most used induction drug, costs only a few dollars per standard 200-mg dose based on ASP pricing (approximately $0.089 per 10 mg).1 Etomidate and ketamine are similarly low-cost, with per-dose expenses generally under a few dollars.2,3 Dexmedetomidine, despite generic availability, remains more expensive on a per-vial basis. A 200-mcg vial costs substantially more than propofol or ketamine, and prolonged infusions can meaningfully increase drug expenditure. Nonetheless, for brief intraoperative use, dexmedetomidine usually contributes only modestly to total anesthetic cost and should be selected based on clinical indication rather than price alone.4
Volatile anesthetics introduce greater cost variability because total cost depends on fresh gas flow and anesthetic potency. Isoflurane is consistently the least expensive volatile agent, offering the lowest cost per minimum alveolar concentration (MAC) hour, though its higher blood–gas solubility may delay emergence.5 Sevoflurane occupies a middle ground, combining favorable pharmacokinetics with moderate cost. When administered at low fresh gas flows, sevoflurane is relatively cost-efficient, often costing only a few dollars per MAC-hour.5 Desflurane, in contrast, is substantially more expensive on a per-hour basis. Despite reduced bottle prices following generic entry, its lower potency results in higher consumption, particularly at higher fresh gas flows. Consequently, desflurane costs several times more per MAC-hour than sevoflurane. These cost considerations, along with growing environmental concerns, have led many institutions to restrict routine desflurane use.5
Intraoperative opioids are generally inexpensive. Fentanyl remains extremely low-cost, with typical dosing well under one dollar per case based on acquisition pricing. Hydromorphone is similarly inexpensive and contributes minimally to total anesthetic cost.1 Remifentanil is the notable exception. While its pharmacokinetic profile is advantageous in select clinical scenarios, its acquisition cost is substantially higher than that of fentanyl. A remifentanil-based anesthetic can add over a hundred dollars per case, depending on infusion duration and dose, making routine use without clear justification a significant cost driver.6,7
Neuromuscular blocking agents themselves are inexpensive. Rocuronium, vecuronium, and succinylcholine typically cost only a few dollars per vial and have minimal impact on per-case drug cost.8-10 The primary cost differential arises during reversal. Neostigmine with glycopyrrolate usually costs only a few dollars per patient, whereas sugammadex remains costly, with a single 200-mg vial priced at approximately $90-$100 at acquisition rates.11 Many patients require one or two vials, making sugammadex a dominant drug cost when used.11
For a typical 1–2-hour elective case using propofol induction, low-flow sevoflurane maintenance, fentanyl, rocuronium, and neostigmine, total anesthetic drug cost may be as low as $20 at wholesale cost benchmarks. Desflurane, sugammadex, and remifentanil are relatively high cost anesthesia medications, though they may be clinically preferred in some cases. At scale, these differences become institutionally significant. Though patient outcomes should drive clinical decisions, awareness of these cost drivers allows anesthesiologists to align clinical judgment with responsible resource stewardship, often without compromising safety or quality of care.
References
1. Centers for Medicare & Medicaid Services. January 2026 Medicare Part B payment limit files. Final file. Published December 19, 2025. Accessed January 2026. https://www.cms.gov
2. Bound Tree Medical. Amidate™ (Etomidate), 2 mg/mL, 10 mL vial. BoundTree.com. Accessed January 4, 2026. https://www.boundtree.com/pharmaceuticals/rx-pharmaceuticals/amidate-etomidate-2mg-ml-10ml-vial/p/6695-01
3. Drugs.com. Ketamine prices, coupons, copay cards & patient assistance. Drugs.com. Updated 2025. Accessed January 4, 2026. https://www.drugs.com/price-guide/ketamine
4. Malotte KL, Walker K, Rosielle DA. Dexmedetomidine. Fast Fact 280. Palliative Care Network of Wisconsin. Published September 5, 2025. Accessed January 4, 2026. https://www.mypcnow.org/fast-fact/dexmedetomidine/
5. Moody AE, Beutler BD, Moody CE. Predicting cost of inhalational anesthesia at low fresh gas flows: impact of a new generation carbon dioxide absorbent. Med Gas Res. 2020;10(2):64-66. doi:10.4103/2045-9912.285558
6. Drugs.com. Remifentanil prices, coupons, copay cards & patient assistance. Drugs.com. Updated 2025. Accessed January 4, 2026. https://www.drugs.com/price-guide/remifentanil
7. Rajamani A, Subramaniam A, Lung B, Masters K, Gresham R, Whitehead C, et al. Remi-fent 1—A pragmatic randomised controlled study to evaluate the feasibility of using remifentanil or fentanyl as sedation adjuncts in mechanically ventilated patients. Crit Care Resusc. 2023;25(4):216-222. doi:10.1016/j.ccrj.2023.10.012. Accessed January 4, 2026. https://www.sciencedirect.com/science/article/pii/S1441277223022238
8. SingleCare. Rocuronium Bromide coupons & prices. SingleCare.com. Accessed January 4, 2026. https://www.singlecare.com/prescription/rocuronium-bromide
9. SingleCare. Vecuronium Bromide coupons & prices. SingleCare.com. Accessed January 4, 2026. https://www.singlecare.com/prescription/vecuronium-bromide
10. SingleCare. Succinylcholine Chloride coupons & prices. SingleCare.com. Accessed January 4, 2026. https://www.singlecare.com/prescription/succinylcholine-chloride
11. Cohen JC, Latchford KJ. Sugammadex in Ontario hospitals: Access and institutional policies. J Eval Clin Pract. 2020;26(1):50-55. doi:10.1111/jep.1315