OBJECTIVES : Neuromuscular blockade and artificial pneumoperitoneum (AP) are important factors to ensure general anesthesia laparoscopic surgery successful. However, residual neuromuscular blockade (rNMB) and AP can lead many potential complications, such as airway obstruction, hypoxemia, respiratory failure, muscular weakness, nausea / vomit, and shoulder pain. The aim of this study was to estimate cost-effectiveness analysis of sugammadex versus neostigmine for reversal of neuromuscular blockade in laparoscopic surgery in China.

METHODS : A decision tree model was developed in Microsoft Excel based on a time horizon of laparoscopic surgery related hospitalization duration. 1,000 patients were simulated by using sugammadex or neostigmine within the model. The model outcome included rNMB / AP related complications frequency and healthcare resource utilization. Clinical efficacy, safety data and cost data were collected from the published literature and 30 physicians’ interview.

RESULTS : The total complications frequency occurred in sugammadex group were less than in the neostigmine group, 621 times versus 1294 times, respectively. Although the sugammadex group was associated with a higher medication cost, the costs related to complications treatment, hospitalization and adverse event in sugammadex group were lower than those in neostigmine group. When compared with neostigmine group, sugammadex group costs a total ¥128.56 more to avoid one rNMB / AP related complication. In comparison, the weighted average cost of each rNMB / AP related complications was ¥932.14. One way sensitivity analysis confirmed the robustness of the model results by varying up or down 10% for all model parameters.

CONCLUSIONS : This economic analysis indicated that, compared with neostigmine group, sugammadex group patients will have slightly higher overall costs but achieve better clinical outcomes by avoiding 674 times of rNMB / AP related complications. This evidence can be used to support clinical decision makers to make informed decisions for treating individual patient to achieve overall better patient outcomes.