FARMAKOEKONOMIKA. Modern Pharmacoeconomic and Pharmacoepidemiology

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Background and Objective. Currently in clinical practice are widely used local anesthetics, including racemic bupivacaine, levo isomer of its levobupivacaine and structurally similar to bupivacaine levo isomer ropivacaine. The aim of this work was to assess the cost of anesthesia
levobupivacaine, bupivacaine and ropivacaine.

Material and methods. In accordance with the results of comparative clinical trials and expert
evaluation analysis was conducted in two ways: under the assumption of equal clinical effectiveness of levobupivacaine and bupivacaine and a higher efficiency of levobupivacaine compared with ropivacaine (assumed in various clinical situations with an equal volume of solution used ropivacaine in concentrations of 0.5% may be replaced without reducing clinical efficacy of levobupivacaine in a concentration of 0.5%, ropivacaine in a concentration of 0.75% – levobupivacaine in a concentration of 0.5 and 0.75% (in equal proportions); ropivacaine at a
concentration of 1% – levobupivacaine at a concentration of 0.75%. The ropivacaine dose equivalent to 1 mg of levobupivacaine, made when calculating the average of 1.20 mg), and under the assumption of equal clinical effectiveness compare local anesthetics. The analysis was carried out for medicines containing 10 ml of solution per ampoule on the basis of registered prices of bupivacaine and ropivacaine. The cost of levobupivacaine was calculated based on expected rates of registration in the case of inclusion in the Essential Drugs List (0,5% R-R amp. 10 ml №10 – 947,74 RUB; 0.75% of p-p amp. 10 ml №10 – 1421,60 RUB).

Results. Subject to the adopted scenario 1 assumptions levobupivacaine allows you to reduce costs 29.6-56.9 per cent compared with bupivacaine and ropivacaine. Taking into account the
consumption of local anesthetics in 2016 (according to IMS Health), the replacement of bupivacaine and ropivacaine by levobupivacaine will allow you to reduce costs on average by 38.0%. Projected savings when replacing bupivacaine and ropivacaine in concentrations of 0.5-1.0% in ampoules of 10 ml will be 69,305 million RUB/year, taking into account the accepted assumptions. Under the assumption of equal effectiveness bupivacaine, ropivacaine and levobupivacaine (scenario 2), the replacement of bupivacaine and ropivacaine on levobupivacaine will reduce costs by an average of 29.6%. Given the amount of consumption savings will be 34,012 million RUB/year.

Conclusion. Replacement of bupivacaine and ropivacaine in concentrations of 0.5-1.0% in vials of 10 ml levobupivacaine at a concentration of 0.5-0.75% will allow taking into account assumptions significantly reduce budget costs without reducing the effectiveness of treatment. Reducing the burden on the budget could be achieved under the assumption of equal efficacy of drugs and replacement of bupivacaine and ropivacaine by levobupivacaine in the same concentration.

About the Authors

G. E. Ulrikh
Saint Petersburg State Pediatric Medical University
Russian Federation

MD, professor of anesthesiology, critical care medicine and emergency pediatrics at St. Petersburg State Pediatric Medical University. Address: ul. Litovskaya, 2, St. Petersburg, Russia, 194100. Tel.: +7(812)5917911

A. V. Rudakova
Saint-Petersburg State Chemical-Pharmaceutical Academy
Russian Federation

MD, Department of Management and Economics Professor of Pharmacy St. Petersburg Chemical-Pharmaceutical Academy. Senior Researcher of Research Institute of medical care childhood infections FMBA. Address: ul. professora Popova, 14, St. Petersburg, Russia, 197376. Tel.: +7(812)4993900


1. Bajwa S., Kaur J. Clinical profile of levobupivacaine in regional anesthesia: A systematic review. Journal of Anaesthesiology Clinical Pharmacology. 2013; 29 (4): 530-539.

2. Baskan S. et al. Comparison of 0.25% levobupivacaine and 0.25% bupivacaine for posterior approach interscalene brachial plexus block. J Anesth. 2010; 24: 38-42.

3. Benhamou D. et al. A Randomized Sequential Allocation Study to Determine the Minimum Effective Analgesic Concentration of Levobupivacaine and Ropivacaine in Patients Receiving Epidural Analgesia for Labor. Anesthesiology. 2003; 99: 1383-6.

4. Cacciapuoti A., Castello G., Francesco A. Levobupivacaina, bupivacaina racemica e ropivacaina nel blocco del plesso brachiale. Minerva Anestesiol. 2002; 68: 599-605.

5. Casati A., Santorsola R., Aldegheri G., Ravasi F., Fanelli G., Berti M. et al. Intraoperative epidural anesthesia and postoperative analgesia with levobupivacaine for major orthopedic surgery: A double-blind, randomized comparison of racemic bupivacaine and ropivacaine. J Clin Anesth. 2003; 15: 126-31.

6. Cox C. R., Faccenda K. A., Gilhooly C. et al. Extradural S(-)-bupivacaine: Comparison with racemic RS-bupivacaine. Br J Anaesth. 1998; 80: 289-93.

7. Cok O. Y., Eker H. E., Turkoz A., Findikcioglu A., Akin S., Aribogan A. et al. Thoracic epidural anesthesia and analgesia during the perioperative period of thoracic surgery: Levobupivacaine versus bupivacaine. J Cardiothorac Vasc Anesth. 2011; 25: 449-54.

8. Di Donato A., Fontana C., Lancia F., Celleno D. Efficacy and comparison of 0.5% levobupivacaine with 0.75% ropivacaine for peribulbar anaesthesia in cataract surgery. European Journal of Anaesthesiology. 2006; 23: 487-490.

9. Fournier R. et al. Levobupivacaine 0.5% Provides Longer Analgesia After Sciatic Nerve Block Using the Labat Approach Than the Same Dose of Ropivacaine in Foot and Ankle Surgery. Anesth Analg. 2010; 110: 1486-9.

10. Frawley G., Smith K. R., Ingelmo P. Relative potencies of bupivacaine, levobupivacaine, and ropivacaine for neonatal spinal anaesthesia. Br J Anaesth. 2009; 103: 731-8.

11. Ghali AM. The efficacy of 0.75% levobupivacaine versus 0.75% ropivacaine for peribulbar anesthesia in vitreoretinal surgery. Saudi J Anaesth. 2012; 6: 22-6.

12. Mageswaran R. et al. Comparison of 0.5% Ropivacaine and 0.5% Levobupivacaine for Infraclavicular Brachial Plexus Block. Med J Malaysia. 2010; 65: 302-5.

13. Papagiannopoulou P., Argiriadou H., Georgiou M. et al. Preincisional local infiltration of levobupivacaine vs ropivacaine for pain control after laparoscopic cholecystectomy. Surg Endosc. 2003; 17: 1961-1964.

14. Piangatelli C. et al. Levobupivacaine and Ropivacaine in the infraclavicular brachial plexux block. Minerva Anesth. 2006; 72 (4): 217-221.

15. Yong Wang M. M., Min Yu Ma M. D., Yan Ping Wang et al. Application of Ropivacaine and Levobupivacaine in Epidural Anesthesia for Gynecological Surgery. The Journal of Reproductive Medicine. 2015; 60 (11-12): 491-494.

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