OBJECTIVES: Sugammadex (SGX) is a modified gamma-cyclodextrin that bonds with rocuronium and vecuronium, leading to reversal of the neuromuscular blockade. The objective of this study was to evaluate the budget impact and the cost-effectiveness of SGX in the routine reversal of patients with neuromuscular block (NMB) from the Spanish National Health System perspective. METHODS: A decision-analytic (DAM) and a budget impact model (BIM) was developed to assess the mean treatment costs per patient (€ 2009), life-years gained (LYG), and incremental cost per LYG of SGX, the spontaneous reversal and neostigmine/atropine in the reversal of patients with NMB. The DAM simulates the probability of experiencing an adverse effect and the direct costs produced by each treatment alternative. The BIM accounts for the time that SGX could save in the operating room (OR), shortening the time to extubation, thereby accelerating the movement of patients in and out of the OR. Clinical data was obtained from the clinical trial performed with SGX, the SmPC of each drug and form secondary sources. Costs were obtained for Soikos database.  RESULTS: In the routine reversal of patients, ROC+SGX is associated with higher costs than the spontaneous reversal or neostigmine/atropine but also with higher LYG. The cost-effectiveness range of SGX vs. neostigmine/atropine varies between €13,26 and 4,976 per LYG, and vs. spontaneous reversal between €6,880 and 17,657 per LYG. In the BIM, SGX could save between 108 and 171 minutes of OR, that would mean that 1 or 2 more surgeries could be performed, and a total budget saved between €1400 and 2000 per OR per day. CONCLUSIONS: Under the established assumptions, SGX would be a cost-effective alternative for the routine reversal of patients with NMB and could be a cost-saving strategy due to the increase of the turn over of the OR.