Economic Analysis of Sugammadex for Neuromuscular Block Reversal for Laparoscopic Surgery from a Single Hospital System in China

OBJECTIVES: This study aims to compare the incidence of residual neuromuscular blockade (rNMB) and postoperative complications for patients undergoing laparoscopy in China, as well as assessing the impact on operating room (OR) and post anesthesia care unit (PACU) efficiency, and the potential cost savings with sugammadex (SUG), neostigmine (NEO) or spontaneous recovery from the hospital perspective.

METHODS: A decision tree model was developed within the perioperative period and 1000 patients were simulated for each group. The incidence of postoperative complications were calculated, including rNMB- and pneumoperitoneum (PP)-related complications and treatment-related adverse events. The time spent in OR and PACU were also reported. Model parameters were obtained from published literature, public data and expert interviews. Costs were expressed in 2023 CNY (¥).

RESULTS: Compared with NEO and spontaneous recovery, brand-name SUG would lead to 292 and 397 fewer postoperative complications respectively. Additionally, the OR time saw a decrease with brand-name SUG use (35.5 hours versus NEO, 82.0 hours versus spontaneous recovery), which could be used to perform 15 and 34 extra laparoscopic surgery respectively. The PACU time was also estimated to decline by 42.6 hours and 98.4 hours respectively. Total time saved in PACU with brand-name SUG could be used to monitor 31 and 71 extra patients. Moreover, SUG was found with more encouraging efficacy in elderly subgroups, and with higher subsequent economic benefits and OR/PACU running efficiency for Chinese hospital (mean net monetary gain were 442 yuan versus generic SUG and 4,887 yuan versus NEO).

CONCLUSIONS: Sugammadex could effectively avoid postoperative complications compared with either NEO or spontaneous recovery, meanwhile reducing both the OR and PACU occupancy, despite a substantially higher medication cost might be followed. It indicates that sugammadex is likely to be an acceptable reversal agent choice in laparoscopy from the Chinese hospital perspective.