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Ann Thorac Surg 2001;72:1798-1799
© 2001 The Society of Thoracic Surgeons

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Correspondence

Cost analysis of diltiazem and nitroglycerin for the prevention of coronary bypass conduit spasm: Reply

^a Department of Cardiothoracic Surgery, Carmel Medical Center, Michal St, Haifa 34362, Israel

e-mail: shapiraoz{at}clalit.org.il

To the Editor

We thank Dr Reddy and her colleagues for their comments on our cost analysis of the use of diltiazem versus nitroglycerin for prevention of coronary bypass conduit spasm [1]. Doctor Reddy and colleagues are correct with respect to the IV dose of diltiazem. The dose of continuous IV diltiazem infusion used in the study was 0.1/kg/hour, not per minute, as was mistakenly published. This is well within the recommended dose range [2, 3]. The daily oral dose of each drug was derived from the total amount of drug given intravenously over the first 24 hours.

The cost analysis in the manuscript was based on the following data, as supplied to us by the Boston University Medical Center pharmacy, reflecting 1998 cost/charge:

Five-mg IV diltiazem bolus plus 24-hr infusion at 5 mg/hr

Cost: $43.01

Charge: $111.77

IV nitroglycerin at 1 µg/kg/min x 24 hrs

Cost: $4.05

Charge: $11.60

Cardizem CD 180 mg PO QD

Cost: $0.94

Charge: $2.63

Imdur 60 mg PO QD

Cost: $0.05

Charge: $0.25

For the purpose of our cost analysis we used cost only.

The total cost per patient for a specific drug was derived from his/her body weight, using the study dosing protocol [1], assuming a 6-month treatment course. In our cost analysis, we used the correct IV dosing of diltiazem. Of note, the observed cost difference is mostly related to the difference in the cost of the oral and not the intravenous medications. We, then, multiplied the cost/patient by the number of patients in each group to obtain the total cost of each drug used in the study. Using these data, we redid the cost analysis and arrived with the same results published.

References

1. Shapira O.M., Alkon J.D., Macron D.S.F., et al. Nitroglycerin is preferable to diltiazem for prevention of coronary artery bypass conduit spasm. Ann Thorac Surg 2000;70:883-889.[Abstract/Free Full Text]
2. Diltiazem Hydrochloride Injection (prescribing information). Deerfield, IL: Baxter Healthcare Corporation, January 1998.
3. Abernethy D.R., Scwartz J.B. Calcium-antagonist drugs. N Engl J Med 1999;341:1447-1457.[Free Full Text]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Oz M. Shapira Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Shapira, O. M. Search for Related Content PubMed Articles by Shapira, O. M. Related Collections Related Article