OBJECTIVES: Sugammadex (SGX) is a modified γ-cyclodextrin that has been recently marketed in Spain for the reversal of neuromuscular block induced by rocuronium (ROC) and vecuronium. The objective of this study was to evaluate the cost-effectiveness of sugammadex in the management of patients with unanticipated difficult intubation and patients needing rapid sequence intubation from the Spanish National Health System perspective. METHODS: Two decision-analytic models were developed to assess the average per patient treatment costs (€2009), life-years gained, and incremental cost per life-year gained of ROC + SGX vs. succinylcholine in patients needing rapid sequence intubation and ROC +SGX vs. all other neuromuscular blocking agents in the management of the unanticipated difficult intubation patients. The models simulate the probability of not being able to intubate, the probability of experiencing an adverse effect, and the direct costs produced by each treatment alternative. Clinical data was obtained from the SmPC of each drug and form secondary sources. Costs were obtained for Soikos database. All data was validated by a focus group in order to adapt the model to the Spanish clinical practice. RESULTS: In the management of unanticipated difficult intubation patients, ROC+SGX is associated with higher life years gained and less costs than the intubation with atracurium or cisatracurium and with a mean cost per life year gained (LYG) of €11,077 vs. succinylcholine based regimens. In the rapid sequence intubation model, ROC+SGX is associated with mean expected costs of €58.11 and mean expected life years of 20.38, and succinylcholine with €57.89 and  20,37, meaning a cost per LYG of ROC+SGX vs succinylcholine of €3106. CONCLUSIONS: Under the established assumptions, sugammadex would be a cost-effective alternative for the reversal of patients with unanticipated difficult intubation or for the management of patients undergoing rapid sequence intubation.