Abstract
Cisatracurium (C), Atracurium (A), Rocuronium (R) and Vecuronium (V) are four neuromuscular blockers (NMB) used in the operating room with similar efficacy, defined as adequate muscle relaxation, but different pharmacokinetics. C and A have organ-independent elimination, A is associated with histamine release and R has a shorter onset time. The objective of this study was to economically compare these four NMB from the hospital point of view in order to facilitate drug selection. A cost analysis was performed. Only direct costs were considered and data were collected through a retrospective chart review. A total of 151 patient charts were randomly selected. Differences between patients receiving one of the four NMB were evaluated by ANOVA or Kruskal-Wallis tests. Then a multiple linear regression analysis was conducted. In the chart review, no significant difference was observed between the four groups of patients in age, weight or surgery duration (p>0.05). Multiple regression analysis revealed that atracurium was on average PTA 237 (1 Euro = PTA 166) cheaper per surgery than any other NMB after adjusting for other factors (p<0.01) and there is no significant difference in cost between the other three NMBs (p>0.1). We recommend the use of rocuronium when a quick onset is needed and the patient does not have hepatic failure, cisatracurium when a haemodynamic instability is possible and atracurium in the remaining cases. If just one NMB can be included in the drug formulary we would select cisatracurium due to its pharmacological advantages over atracurium with a small increment in cost.
References
Bryson HM, Faulds D. Cisatracurium besilate. A Review of its pharmacology and clinical potential in anaesthetic practice. Drugs 1997;53:848-66.
Siler JN, Mager JG JR, Wyche MQ Jr. Atracurium: hypotension, tachycardia and bronchospasm. Anesthesiology 1985;62:645-6.
Tsui D, Graham GG, Torda TA. The pharmacokinetics of atracurium isomers in vitro and in humans. Anesthesiology 1987;67:722-8.
Belmont MR, Lien CA, Quessy S, Abou-Donia MM, Abalos A, Eppich L et al. The clinical neuromuscular pharmacology of 51W89 in patients receiving nitrous oxide/opioid/barbiturate anesthesia. Anesthesiology 1995;82:1139-45.
Lepage JY, Malinovsky JM, Malinge M, Cozian A, Pinaud M. 51W89: Dose-response, neuromuscular blocking profile and cardiovascular effects. Anesthesiology 1993;79(Suppl 3A): A945.
Bluestein LS, Stinson LW, Lennon RL, Quessy SN, Wilson RM. Evaluation of cisatracurium, a new neuromuscular blocking agent, for tracheal intubation. Can J Anaesth 1996;43:925-31.
Rhodes SP, Ridley S. Economic aspects of general anaesthesia. Pharmacoeconomics 1993;3:124-30.
Colosimo R, Levon JV. Cisatracurium. The newest nondepolarizing NMBA. P&T 1997; Jan:23-39.
Loughlin KA, Weingarten CM, Nagelhout J, Stevenson JG. A pharmacoeconomic analysis of neuromuscular blocking agents in the operating room. Pharmacotherapy 1996;16: 942-50.
Torrance GW, Blaker D, Detsky A, Kennedy W, Schubert F, Menon D et al. Canadian guidelines for economic evaluation of pharmaceuticals. Pharmacoeconomics 1996; 9:535-59.
Rovira J, AntoÒanzas F. Economic analysis of health technologies and programmes. A Spanish proposal for methodological standardisation. Pharmacoeconomics 1995;8:245-52.
Fisher DM. Surrogate end points. Are they meaningful? Anesthesiology 1994;81:795-6.
Fulton B and Goa KL. Propofol. Pharmacoeconomic appraisal of its use in day case surgery. Pharmacoeconomics 1996;9:168-78.
Lien CA, Belmont MR, Abalos A, Eppich L, Quessy S, Abou-Donia MM et al. The cardiovascular effects and histaminereleasing properties of 51W89 inpatients receiving nitrous oxide/opioid/barbiturate anesthesia. Anesthesiology 1995;82:1131-8.
Miller RD. Is 51W89 an improvement compared with atracurium? Br J Anaesth 1995;74:1-2.
Hunter JM. New neuromuscular blocking drugs. N Engl J Med 1995;332:1691-99.
Schramm WM, Papousek A, Michalek-Sauberer A, Czech T, Illievich U. The cerebral and cardiovascular effects of cisatracurium and atracurium in neurosurgical patients. Anesth Analg 1998;86:123-7.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Ortega, A., Sarobe, C., Giráldez, J. et al. Cost analysis of neuromuscular blocking agents in the operating room: cisatracurium, atracurium, vecuronium and rocuronium. Pharm World Sci 22, 82–87 (2000). https://doi.org/10.1023/A:1008737332389
Published:
Issue Date:
DOI: https://doi.org/10.1023/A:1008737332389