The pharmacoeconomics of neuromuscular blocking drugs: A perioperative cost-minimization strategy in children

The purpose of this investigation was to compare the costs of intermediate- acting neuromuscular blocking drugs in children during routine ambulatory s urgery. We studied 200 healthy, 2-10-yr-old children undergoing elective de ntal restorative surgery. During Part 1 of the study, children received an inhaled anesthetic with halothane and nitrous oxide, whereas in Part 2, the anesthetic was IV propofol with nitrous oxide. The study drugs were atracu rium, cisatracurium, mivacurium, rocuronium, and vecuronium. Patients were initially administered 2 X the effective dose for 95% of the study drug. Af ter recovery to 10% of baseline neuromuscular function, the neuromuscular b lockade was rigidly maintained with an infusion of the study drug at about 10% of baseline function. Neuromuscular drug costs were approximated as dru g usage X cost/unit. The initial drug costs were not substantially differen t for both Parts 1 and 2, but over time, mivacurium, became the most expens ive drug and cisatracurium the least expensive. In conclusion, based on cur rent costs, cisatracurium is the least expensive intermediate-acting neurom uscular drug.