Pre-filled syringes of ephedrine and metaraminol lead to cost savings

Background

Ephedrine and metaraminol are sympathomimetic agents used to treat hypotension during surgeries and critical illness. In recent years, both drugs have become available as pre-filled syringes, previously only available as ampoules. In 2022 metaraminol syringes became available, costing around 2.8 times more than an ampoule. In June 2023, the cost of ephedrine ampoules tripled, while pre-filled syringes became available at a similar cost as the ampoules previously.

Objectives

This study aimed to establish how the availability of ephedrine and metaraminol pre-filled syringes affected anaesthetists’ current practice, by:

1. Examining the number of supplies made from acute hospital stores over one year
2. Identifying the cost implications from differing usage patterns of ephedrine
3. Gathering anaesthetists’ opinions on pre-filled syringes.

Methods

Data was collected in retrospect from February 2023 to February 2024, using the hospitals’ electronic stock system to gather cost information and issue history of ephedrine and metaraminol products. In March 2024, an online questionnaire was distributed to consultant anaesthetists and specialty doctors to capture their views on the use of pre-filled syringes.

Results

Data shows a notable changeover from ephedrine ampoules to syringes and monthly average use of ephedrine decreased by approximately 25%. This reduction may be explained by the need to prepare ampoules in advance of procedures, leading to waste if not used, while syringes can be stored for future use. Critical care settings commonly require metaraminol infusions (using ampoules), this may account for the approximate 50:50 supply of syringes and ampoules across the one year period.

After the price increase, the average monthly spend on ephedrine ampoules would have been approximately £5430. Switching primarily to syringes has resulted in around a £3000 monthly cost avoidance, since monthly expenditure dropped to around £1430.

A 44% (22/50) questionnaire response rate was achieved. Anaesthetists expressed an overall positive reaction to syringes, stating easier use in practice, saving time and reducing drug waste. However, an increase in packaging waste was reported.

Conclusion

Current practice has changed since syringes became available. The use of ephedrine has primarily changed to syringes, resulting in significant cost avoidance, not accounting for savings from a lack of consumables. Preference of metaraminol formulation is dependent on indication, syringes are preferred in patients requiring one or two doses of metaraminol, and ampoules for infusions and intramuscular administration. Cost implications for metaraminol were not discussed as breakdown of infusion usage was not clear. These results are from one hospital, within a single health board, so may not be an accurate representation of changes observed within the rest of the UK.

Additional authors: Helena Nicholls & Alan Timmins, Victoria Hospital, NHS Fife

The opinions expressed in this article are those of the author. They do not purport to reflect the opinions or views of the UKCPA or its members. We encourage readers to follow links and references to primary research papers and guidance.

Competing interest statement:

The author declares: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.