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 although 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 adul ts only). We found that 88% of the cost per dose of succinylcholine was for the chance of dying or sustaining permanent brain injury from anaphylactic or anaphylactoid reactions to succinylcholine. Consequently, the estimated cost per dose of succinylcholine was sensitive to the incidence of anaphyl actic or anaphylactoid reactions to succinylcholine, the risk of severe inj ury from anaphylactic or anaphylactoid reactions, and the financial value o f unforeseen instant death or permanent brain injury. The range for the cos t 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 cost per 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.