Cost-effectiveness analysis of neuromuscular blocking agents (NMBAs) used in the intensive care units

Purpose: To evaluate the cost-effectiveness of Cisatracurium (CIS) versus the following intermediate-acting NMBAs: Atracurium (ATR), Rocuronium (ROC), and Vecuronium (VEC). Methods: 8 pts in either the MICU or SICU prospectively received CIS by continuous infusion (CI). These pts were historically matched according to NMBA length of therapy (LOT), with at least one of each of the other agents given by CI. Demographic data, NMBA used, dosing requirements, costs of the agents/day, LOT, train of four (TOF) monitoring, adverse events, and time to spontaneous movement were collected. All pts received appropriate concomitant sedation/analgesia white on the NMBAs. Effectiveness of NMBA therapy was monitored for all agents by frequent assessments (q1-2h) of peripheral nerve stimulation using TOF and clinical assessments. Statistics were performed using one-way ANOVA. Results: There were no statistical differences in age, weight, and APACHE II scores between groups. Average recovery times for all pts after discontinuing NMBAs was less than 3 hrs. Clinical efficacy and toxicity were equivalent for all of the NMBAs. No adverse events (AE) were reported due to the NMBAs. Doses (normalized to 70 kg) and costs are reported as means ± standard deviations: n Dose/Day(mg) Drug Cost/Day($) n Dose/Day(mg) Drug Cost/Day($) Group 1 (0-2.5 d) Group 3 (4-10 d) CIS 4 234.8±107.2 159.1±72.61 1 361.7 245.1 ROC 5 577.2±151.4 1209±317.1 3 868.9±249.1 1820±521.8 ATR 4 591.3±247.9 829.7±347.8 2 995.2±35.94 1396±50.43 VEC 4 146.7±153.2 1888±1973 2 48.56±11.30 625.1±145.4 Group 2 (2.5-4 d) Group 4 (>10 d) CIS 2 308.8±17.31 209.3±11.73 1 206.7 140.0 ROC 4 633.2±160.5 1326±336.1 1 968.1 2028 ATR 3 571.7±122.0 802.2±171.1 1 919.2 1290 VEC 2 79.00±27.61 1017±355.5 1 47.53 611.8 Conclusions: All pts were dosed appropriately based on TOF monitoring and clinical response. No pts experienced prolonged NMB as the longest time to recovery was 6.5 hrs. The cost of CIS therapy compared to the other NMBAs studied was significantly less in all groups (p<0.01). Given the similarities among efficacy, time to recovery, and AE profiles, CIS is a cost-effective alternative NMBA.