Cost identification analysis for succinylcholine

The cost of a dose of succinylcholine from society's perspective equals the acquisition cost of the drug plus the cost of its adverse outcomes. We hyp othesized that al though the acquisition cost of succinylcholine is minimal , the true cost would be much larger. We reviewed the medical literature to identify the total cost of a dose of succinylcholine when administered for nonemergency purposes according to manufacturers' guidelines (i.e., to adu lts only). We found that 88% of the cost per dose of succinylcholine was fo r the chance of dying or sustaining permanent brain injury from anaphylacti c or anaphylactoid reactions to succinylcholine. Consequently, the estimate d cost per dose of succinylcholine was sensitive to the incidence of anaphy lactic or anaphylactoid reactions to succinylcholine, the risk of severe in jury from anaphylactic or anaphylactoid reactions, and the financial value of unforeseen instant death or permanent brain injury. The range for the co st per dose of succinylcholine was thus large, $9 to $93. Our best estimate of the cost per dose was $37. We conclude that the true costper dose of su ccinylcholine from society's perspective is more than 20 times the acquisit ion cost. However, a precise costing requires better knowledge of the incid ence and consequences of anaphylactic or anaphylactoid reactions to succiny lcholine.