title: Cost-effective reduction of neuromuscular-blocking drug expenditures.
abstract: BACKGROUND
  Anesthetic drug expenditures have been a focus of cost-containment efforts. The aim of this study was to determine whether expenditures for neuromuscular-blocking agents could be reduced without compromising outcome, and to determine whether such a cost-effective pattern of neuromuscular blocker use could be sustained.
  
  
  METHODS
  Education, practice guidelines, and paperwork barriers were used to persuade anesthesiologists to substitute low-cost neuromuscular-blocking drugs (pancuronium or a metocurine-pancuronium combination) for a more costly neuromuscular-blocking drug (vecuronium). Neuromuscular-blocking drug use in all patients during a historical control period (6 months; n = 4,804) was compared with that during two consecutive 1-yr periods of intervention (n = 9,761/n = 10,695). Expenditures for vecuronium and for all neuromuscular-blocking drugs were compared for the control and intervention periods. The rate of complications related to neuromuscular-blocking drugs was determined by an ongoing continuous quality improvement program.
  
  
  RESULTS
  Vecuronium use decreased by 76% during the first and second yr of intervention, compared with the historical period (P < 0.01). The cost of neuromuscular-blocking drugs decreased by 31% (P < 0.01) and 47% (P < 0.01) for the first and second yr, respectively. The complication rate related to neuromuscular-blocking drugs was 0.081% in the historical period and 0.11% and 0.093% during the intervention periods (P = 0.29 and 0.41).
  
  
  CONCLUSIONS
  Practice guidelines, education, and paperwork barriers used together substantially reduced the expenditures for neuromuscular-blocking drugs for 2 yr without adversely affecting clinical outcome.
authors.affiliation: University of Washington Medical Center, Seattle 98195, USA. freund@u.washington.edu
authors.forename: P R
authors.initials: PR
authors.lastname: Freund
authors.forename: T A
authors.initials: TA
authors.lastname: Bowdle
authors.forename: K L
authors.initials: KL
authors.lastname: Posner
authors.forename: E D
authors.initials: ED
authors.lastname: Kharasch
authors.forename: V D
authors.initials: VD
authors.lastname: Burkhart
mesh_terms: D000328:Adult; D003362:Cost-Benefit Analysis; D016527:Drug Costs; D006801:Humans; D008875:Middle Aged; D009466:Neuromuscular Blocking Agents / Q000494:pharmacology*; D010197:Pancuronium / Q000494:pharmacology; D014673:Vecuronium Bromide / Q000494:pharmacology
chemical_list: D009466:Neuromuscular Blocking Agents; D014673:Vecuronium Bromide; D010197:Pancuronium