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ECONOMICS AND HEALTH SYSTEMS RESEARCH

Cost Identification Analysis for Succinylcholine

Franklin Dexter, MD, PhD^*, Tong J. Gan, MB, FRCA, FFARCSI, Mohamed Naguib, MB, BCh, MSc, FFARCSI, MD^*, and David A. Lubarsky, MD, MBA

*Department of Anesthesia, University of Iowa, Iowa City, Iowa; Department of Anesthesiology, Fuqua School of Business, Duke University, Durham, North Carolina

Address correspondence to Franklin Dexter, Department of Anesthesia, University of Iowa, Iowa City, IA 52242. Address e-mail to franklin-dexter{at}uiowa.edu

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 hypothesized 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 adults 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 anaphylactic or anaphylactoid reactions to succinylcholine, the risk of severe injury from anaphylactic or anaphylactoid reactions, and the financial value of unforeseen instant death or permanent brain injury. The range for the cost 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 succinylcholine from society’s perspective is more than 20 times the acquisition cost. However, a precise costing requires better knowledge of the incidence and consequences of anaphylactic or anaphylactoid reactions to succinylcholine.

Implications: The true cost of succinylcholine is more than 20 times the acquisition cost of the drug. The estimated cost is very sensitive to the risk and cost of patients dying or sustaining brain injury from anaphylactic or anaphylactoid reactions to succinylcholine.

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Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999