Pharmacoeconomic issues related to selection of neuromuscular blocking agents

Pharmacoeconomic issues related to the selection of neuromuscular blocking agents are described. Five models of economic analysis are commonly used in health care: cost-minimization, cost-benefit, cost-effectiveness, cost-utility, and cost-of-illness. The model used most commonly in anesthesiology is the cost-effectiveness model, in which outcomes are measured in nonmonetary terms that are then translated into units of success or failure. The true cost of anesthetic drugs and techniques should include more than acquisition cost. Factors typically included in economic analyses include resources used and humanistic factors. Six specific indirect costs should be included in pharmacoeconomic analyses of neuromuscular blocking agents: cost of residual muscle blockade, cost of prolonged time to extubation, inability of patients to resume normal activities because of postoperative myalgia, cost of additional postoperative monitoring for arrhythmia associated with reversal drugs, and risk of nausea and vomiting associated with reversal drugs. The availability of rapid-onset, shorter-duration anesthetics, analgesics, and neuromuscular blocking agents with fewer adverse effects and the availability of less invasive surgical techniques have made it possible to accelerate the movement of patients in and out of the operating room and have shortened lengths of stay in the postanesthesia care unit (PACU) and the intensive care unit (ICU). Decreased length of stay in the PACU and the ICU can save hundreds of dollars per case because these areas have high personnel costs. If reversal drugs like neostigmine can be avoided, fewer patients may experience postoperative nausea and vomiting and the resulting complications. In searching for the best outcome at the most reasonable cost, practitioners should look for meaningful cost reductions, bearing in mind that the use of newer, shorter-acting drugs has led to improved perioperative efficiency in clinical practice.