Loughlin K A, Weingarten C M, Nagelhout J, Stevenson J G
Department of Pharmacy, Detroit Receiving Hospital, MI 48201, USA.
Pharmacotherapy. 1996 Sep-Oct;16(5):942-50.
A cost-minimization analysis was performed to compare the direct costs of various neuromuscular blocking agents (NMBAs) in procedures of specific durations. Secondary objectives were to review the role of the NMBAs studied with respect to their place on our hospital formulary, and to develop a pharmacoeconomic methodology to be applied to other formulary decisions. Patients were stratified according to estimated length of surgical procedure; group 1 (55 patients) included surgeries estimated to take less than 2 hours, and group 2 (55 patients) included those estimated to be 2-4 hours long. Patients were then randomized to one of three intermediate-acting NMBAs: atracurium, vecuronium, or rocuronium. Anesthesia records were used to obtain all anesthetic agents administered in the operating room, and drug costs were calculated from hospital drug acquisition costs as of December 1994. Postanesthesia care unit (PACU) costs were estimated from patient charges and converted to costs using our hospital's cost-to-charge ratio. Costs that were common to all study treatments or unrelated to the use of NMBAs were excluded from the analysis. Two time-adjusted costs were calculated to determine the cost of neuromuscular blockade/hour and the total anesthesia drug costs/hour. In group 1 there were no statistical differences in NMBA cost/hour, anesthesia cost/hour, or PACU times or costs. In group 2, a significant difference was found in NMBA cost/case between atracurium ($54.23 +/- 41.26, mean +/- SD) and vecuronium ($31.95 +/- 15.33, p = 0.046). Atracurium was also significantly more costly than either vecuronium or recuronium/hour ($21.95 +/- 7.42 vs $14.39 +/- 7.02 and $16.07 +/- 8.15, respectively, p = 0.011) and anesthesia cost/hour ($28.77 +/- 7.43 vs $ 22.82 +/- 7.46 and $23.32 +/- 6.54, respectively, p = 0.03). There were no differences in PACU times or costs. Based on these results, vecuronium or rocuronium is preferred over atracurium in procedures with an estimated duration of 2-4 hours. In the patient population evaluated, there were no significant cost differences among the three NMBAs in surgeries with an estimated duration of less than 2 hours.
进行了一项成本最小化分析，以比较不同神经肌肉阻滞剂（NMBAs）在特定时长手术中的直接成本。次要目标是评估所研究的NMBAs在我院药品目录中的地位，以及开发一种可应用于其他药品目录决策的药物经济学方法。患者根据预计手术时长进行分层；第1组（55例患者）包括预计手术时长小于2小时的手术，第2组（55例患者）包括预计手术时长为2 - 4小时的手术。然后将患者随机分为三种中效NMBAs之一：阿曲库铵、维库溴铵或罗库溴铵。利用麻醉记录获取手术室使用的所有麻醉剂，并根据1994年12月医院药品采购成本计算药物成本。术后麻醉恢复室（PACU）成本根据患者收费估算，并使用我院成本与收费比率换算为成本。所有研究治疗共有的成本或与NMBAs使用无关的成本被排除在分析之外。计算了两个时间调整成本，以确定每小时神经肌肉阻滞成本和每小时总麻醉药物成本。在第1组中，NMBA每小时成本、麻醉每小时成本、PACU时长或成本无统计学差异。在第2组中，阿曲库铵（54.23美元±41.26美元，均值±标准差）与维库溴铵（31.95美元±15.33美元，p = 0.046）之间的NMBA每例成本存在显著差异。阿曲库铵每小时的成本也显著高于维库溴铵或罗库溴铵（分别为21.95美元±7.42美元与14.39美元±7.02美元和16.07美元±8.15美元，p = 0.011）以及麻醉每小时成本（分别为$28.77 ± 7.43与$ 22.82 ± 7.46和$23.32 ± 6.54，p = 0.03）。PACU时长或成本无差异。基于这些结果，在预计时长为2 - 4小时的手术中，维库溴铵或罗库溴铵优于阿曲库铵。在所评估的患者群体中，预计时长小于2小时的手术中，三种NMBAs之间无显著成本差异。
