Hyperinflation of Vasopressors (Vasopressin, Norepinephrine, Ephedrine, etc).

PURPOSE: Hyperinflation refers to the increasing cost of drugs which occurs due to continued drug shortages and rebranding. Hyperinflation has significant implications in increasing overall healthcare costs with reduced reimbursement, increased patient acuity, and an aging population, but published strategies to reduce costs and minimize waste are limited. OBJECTIVE: To describe the hyperinflation and cost mitigation strategies of three vasopressor medications, vasopressin, epinephrine, and ephedrine. CONCLUSION: The steep increase in medications is expected to continue, and mitigation strategies to reduce waste and select the most cost effective therapy to offset the price increase is crucial for healthcare systems.

Estimated economic impact of pre-filled ephedrine syringes in the operating room.

BACKGROUND: Syringes of ephedrine are usually prepared ahead of time in order to reduce the time to injection. Commercial pre-filled syringes of ephedrine have been introduced to minimize the amount of waste. Our primary objective was to determine the economic impact of commercial syringes. We hypothesized that costs could be reduced compared to standard syringes. METHODS: Using data extracted from our medical records system, we retrospectively measured the total dose of ephedrine received per patient in 2013 to estimate the number of administered standard syringes. The proportion of administered standard syringes was calculated as the total number of administered standard syringes divided by the number of delivered ampoules in 2013. Thereafter, we calculated the annual cost difference as the difference between the cost for commercial syringes and the cost for standard syringes. Endpoints were calculated overall and for each operating room. RESULTS: At least one dose of ephedrine was given in 19,422 patients (44,943 administrations). The overall proportion of administered standard syringes was estimated to 52.8%. The threshold proportion of administered standard syringes for which commercial syringes would add no extra cost was 20.4%. In 30/32 operating rooms, the proportion of administered standard syringes was higher than 20.4%. The overall cost increase with commercial syringes was estimated to 51,567 €. Among operating rooms, incremental costs varied between -703 and 5086 €. CONCLUSION: Based on our findings, pre-filled ephedrine commercial syringes do not appear to reduce costs.

[Economic impact of strategies using ephedrine prefilled syringes]. / Impact économique des stratégies de recours à l'éphédrine en seringues préremplies.

OBJECTIVES: Ephedrine is an emergency drug available in ampules and syringes need to be prepared in advance according to one of two strategies in our establishment: strategy 1 (S1: 1 ampule per patient) and strategy 2 (S2: 1 ampule per operating room). There are also prefilled syringes. Because of their high cost and conflicting results in the literature, we assessed the economic interest of using prefilled syringes compared with strategies S1 and S2. TYPE OF STUDY: This was a prospective observational study. PATIENTS AND METHODS: The consumption of ephedrine was recorded over two periods of 14 days: P1 with syringes prepared in advance according to S1 or S2 and P2 with the on-demand use of prefilled syringes. RESULTS: The cost of a syringe of ephedrine prepared in advance (nurse time preparation included) was evaluated at €1.65 vs. €3.57 for a prefilled syringe. In operating rooms using S1, the use of prefilled syringes reduced overall the cost per patient about €1.22 and global annual costs by 72% (€2830), while the decrease was about €0.32 for the cost per patient and about 47% (€2760) for global annual costs for operating rooms using S2. CONCLUSION: The interest of our study is that we investigated different supply strategies for ephedrine within a large number of operating rooms. In our establishment, it was decided to use prefilled syringes in operating rooms that used S1. As well as the economic interest, prefilled syringes contributed to improved safety and saved nursing time.

[Use of ephedrine prefilled syringes reduces anesthesia costs]. / Réduction des coûts grâce à l'utilisation des seringues préremplies d'éphédrine.

OBJECTIVE: The aim of the present study was to compare the consumption and cost of ephedrine in parturients with respect to two packagings: ampoules and prefilled syringes. STUDY DESIGN: Prospective observational study in a French university obstetrical unit. PATIENTS AND METHODS: Assessing the consumption and cost of ephedrine during two consecutive periods of 14 days: use of ampoules for period 1 (P1) versus use of prefilled syringes for period 2 (P2). Consumption was daily evaluated. The costs (ampoules and consumable supplies for P1 and prefilled syringes for P2) were calculated on the basis of the price list given by our institutional pharmacy. The number of parturients and the anaesthetic techniques which were performed were prospectively recorded. RESULTS: One hundred and thirteen parturients were managed for the present study. The number of parturients and the anaesthetic care were similar between the two periods. In contrast, 155 ampoules were used for P1 versus 45 prefilled syringes for P2 (p<0.0001). The cost per parturient was 3.1 euro for P1 versus 2.6 euro for P2, i.e. 0.5 euro was saved for each parturient. CONCLUSION: The results of the present study show that the use of prefilled syringes reduces significantly the wastage of ephedrine, allowing subsequent cost minimization in obstetrical anaesthesia.