OBJECTIVES

: Neuromuscular blocking agents (NMBAs) are often administered to prevent patient movement during surgical procedures requiring use of general anesthetics, which can increase the risk of post-operative respiratory complications. Sugammadex is indicated to reverse neuromuscular blockade induced by rocuronium or vecuronium in adults and can efficiently reduce both moderate and deep levels of neuromuscular block. The aim of this study is to estimate clinical and economic impact of sugammadex in routine reversal of neuromuscular blockade with rocuronium in Spain.

METHODS

: A budget impact model was developed to estimate the aggregated annual net budget impact of substituting sugammadex for neostigmine or no reversal agent in a proportion of patients administered with rocuronium. According to the local data, the annual number of hospital procedures in Spain was 733,876; 73.3% of them would use a NMBA. Rocuronium was administered in 64% of those procedures. Payer perspective was used in the analysis, including only the direct costs associated with post-operative pneumonias and atelectasis and drugs costs. One way sensitivity analysis was carried out by varying each parameter included in the model within a range of +/-50%.

RESULTS

: The estimated budget impact of the introduction of sugammadex to the routine reversal of neuromuscular blockade in Spanish hospitals was a net saving of €57.1 million annually. A rise in drug acquisition costs was offset by savings in post-operative respiratory events including 4,806 post-operative pneumonias and 13,996 cases of atelectasis. The total cost of complications avoided was €70.4 million. All scenarios tested in sensitivity analysis were favorable to the alternative scenario.

CONCLUSIONS

: Improving patient safety in the operation room is essential in surgical procedures where neuromuscular blocking agents with rocuronium are required. The clinical benefits in terms of avoided pneumonias and atelectasis with sugammadex would produce net savings for the Spanish National Healthcare System.