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-min imization, rest-benefit, cost-effectiveness, cost-utility, and cost-of-illn ess. The model used most commonly in anesthesiology is the cost-effectivene ss model, in which outcomes are measured in nonmonetary terms that are then translated into units of successor failure. The true cost of anesthetic dr ugs and techniques should include more than acquisition cost. Factors typic ally included in economic analyses include resources used and humanistic: f actors. 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 nor mal activities because of postoperative myalgia, cost of additional postope rative monitoring for arrhythmia associated with reversal drugs, and risk o f nausea and vomiting associated with reversal drugs. The. availability of rapid-onset, shorter-duration anesthetics; analgesics, and:neuromuscular bl ocking agents with fewer adverse effects and the availability of less invas ive surgical techniques have made it possible to accelerate the movement of patients in and out-of the operating room and have shortened lengths of st ay in the postanesthesia care unit(PACU) and the intensive rare unit (ICU). Decreased length df stay in. the PACU and the ICU can save hundreds of dol lars per case because these areas have high personnel costs. If reversal dr ugs like neostigmine can be avoided, fewer patients may experience postoper ative nausea and vomiting and the resulting complications. In searching for the best outcome at the most reasonable cost, practitioner s 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.