Abstracts of Posters Presented at the International Anesthesia Research Society; 72nd Clinical and Scientific Congress; Orlando, FL; March 7-11, 1998: Anesthesia/OR Economics
Cost containment has been a major issue for anesthesiologists. Our hospital indicated that the major budget item of anesthesia drugs was neuromuscular blocking agents (NMB). Our cost containment committee evaluated the relative costs of the 5 major intermediate acting neuromuscular blocking agents (A-E) and determined that a recently introduced drug (E) was associated with the lowest cost. We undertook a voluntary program to encourage its use by educating the department members about the cost. We later introduced a restricted use program. In the restrictive program, drugs A-D were readily available, but had to be specially requisitioned from the OR pharmacy with a sheet documenting why this drug was the drug of choice.
METHODS: This institutionally approved retrospective study was undertaken to determine the effectiveness of each program. The pharmacy records of the hospital were acquired to determine the amount of each intermediate acting NMB used each month. Usage of drugs for the intensive care units was removed from the data. The data were pooled for three periods: 1. prior to the voluntary program (6 months), 2. during the voluntary program (6 months), and 3. during the restrictive program (4 months). A 1 month transition period between each period was eliminated from the data. To compare drugs, all milligrams of drug usage were converted to equivalent mg of one agent by comparing the infusion rates of drug needed to maintain a train of four at 1 of 4 twitches. Percent usage was calculated for each drug in each period.
RESULTS: Shown on the graph is the percent usage of each drug in the three time periods. Drug E, the targeted drug, was used very little in period 1. Use of drug E increased to near 56% under the voluntary program and Drug B was not used. With the restrictive program, Drug C was no longer used and Drug E usage increased to 96% with other drugs being used for specific indications where Drug E was not acceptible.
CONCLUSIONS: This study suggests that education can be an effective method to change drug usage, however, changing usage patterns may require a more restrictive method to be optimally effective. (Figure 1)