COST-EFFECTIVE REDUCTION OF NEUROMUSCULAR-BLOCKING DRUG EXPENDITURES

Background: Anesthetic drug expenditures have been a focus of cost-con tainment efforts, The aim of this study was to determine whether expen ditures for neuromuscular-blocking agents could be reduced without com promising outcome, and to determine whether such a cost-effective patt ern of neuromuscular blocker use could be sustained. Methods: Educatio n, practice guidelines, and paperwork barriers were used to persuade a nesthesiologists to substitute low-cost neuromuscular-blocking drugs ( pancuronium or a metocurine-pancuronium combination) for a more costly neuromuscular-blocking-drug (vecuronium). Neuromuscular-blocking drug nse in all patients during a historical control period (6 months; n = 4,804) was compared with that during two consecutive 1-yr periods of intervention (n = 9,761/n = 10,695). Expenditures for vecuronium and f ear an neuromuscular-blocking drugs were compared for the control and intervention periods, The rate of complications related to neuromuscul ar-blocking drugs was determined by an ongoing continuous quality impr ovement program, Results: Vecuronium use decreased by 76% during the f irst and second yr of intervention, compared with the historical perio d (P < 0.01). The cost of neuromuscular-blocking drugs decreased by 31 % (P < 0.01) and 47% (P < 0.01) for the first and second Ivr, respecti vely. The complication rare related to neuromuscular-blocking drugs wa s 0.081% in the historical period and 0.11% and 0.093% during the inte rvention periods (P = 0.29 and 0.41). Conclusion: Practice guidelines, education, and paperwork barriers used together substantially reduced the expenditures for neuromuscular-blocking drugs for 2 yr without ad versely affecting clinical outcome.