OBJECTIVES: Sugammadex (Bridion®), a modifiedγ-cyclodextrin, is the first selective relaxant binding agent for the reversal of neuromuscular blockade (NMB). This study aimed to efficiently evaluate the clinical effectiveness and cost-effectiveness of sugammadex to meet the needs of decision making.

METHODS: We systematically searched the databases (including PUBMED, EMBASE, the Cochrane Library, CNKI, WanFang database) and websites of Health Technology Assessment (HTA) organizations to identify systematic reviews, pharmacoeconomic studies and HTA reports of sugammadex versus placebo or active comparators for reversal of NMB. After independent study selection, data extraction and quality assessment, included studies were comprehensively analyzed as appropriate.

RESULTS: Seven systematic reviews, five pharmacoeconomic studies and two HTA reports were included. The results suggested that, compared with neostigmine or placebo, sugammadex significantly reduced the time to reverse rocuronium or vecuronium-induced neuromuscular blockade (range of weighted mean difference: -46.36 to -10.22 min, P<0.05) and the incidence of postoperative residual blockade (range of risk ratio: 0.40 to 0.46, P<0.05) in adults. Sugammadex did not increase the incidence of general adverse effects compared to placebo, and had similar or significantly lower incidence of general adverse events, postoperative nausea or vomiting and respiratory events, compared with neostigmine. Sugammadex was also associated with significantly lower risk of bradycardia and postoperative weakness. In comparison with neostigmine(+glycopyrrolate), sugammadex was a cost-effective or even cost-saving option, which was resulted from various clinical benefits including remarkable less time to discharge to surgical ward, shorter duration of operating room occupancy, and avoiding costly postoperative complications such as residual curarization-related intensive care unit admission.

CONCLUSIONS: In the management of NMB, sugammadex was proved to be superior to neostigmine by state-of-the-art evidence, not only for the better efficacy and safety profiles, but also for its favorable economic impacts on patients and medical resource utilization.