OBJECTIVES: Sugammadex can offer more complete and predictable recovery from rocuronium- and vecuronium-induced NMB than cholinesterase inhibitors, such as neostigmine. However, despite clinical benefits, cost pressures can often impact the choice of NMB reversal method. This study aimed to evaluate the budget impact of sugammadex for the routine NMB reversal in a Brazilian private healthcare setting.

METHODS: A decision analytical model was adapted to estimate the budget impact associated with the introduction of sugammadex. The model considered reversal agent costs, and costs and event counts of atelectasis, pneumonia and re-admissions due to infections. A hypothetical cohort of 1,000 eligible surgical (moderate NMB) procedures were considered, and two scenarios were compared (sugammadex only and neostigmine only). Analyses were performed for 1) patients with an average weight of 70kg, and 2) patients undergoing bariatric surgery with an average weight of 120kg. Comparative data on the risks of these clinical events were obtained from international studies. The dosage considered was 2mg/kg for sugammadex and 0.05mg/kg for neostigmine with a maximum of 3.5mg plus 1mg atropine. Drug costs were available in Brasíndice (May 2019, factory price with 18% ICMS), and cost of managing clinical outcomes were based on a micro-costing study (R$686 for atelectasis, R$14,416 for re-admission and R$4,729 for pneumonia; exchange rate R$4.07 to US$1).

RESULTS: In the first population, there were 247 total events with neostigmine, costing R$2,182,789 versus 104 with sugammadex with a cost of R$1,150,617, reducing 144 events and saving R$1,032,172. Including the drugs acquisition cost, the total savings were R$702,934. Considering only patients undergoing bariatric surgeries, the total savings were R$366,029.

CONCLUSIONS: The use of sugammadex for routine NMB reversal reduces the risk of residual NMB and its sequelae and results in overall net cost savings, with average patient savings of R$366 to R$703.