Unrestricted Access to Sugammadex: Impact on Neuromuscular Blocking Agent Choice, Reversal Practice and Associated Healthcare Costs

Abstract

Sugammadex is known to rapidly and completely reverse the effects of amino-steroidal neuromuscular blocking agents. However, the high costs of sugammadex have so far prevented its introduction as the standard reversal agent in most healthcare systems. At the Royal Perth Hospital, sugammadex was recently introduced as an unrestricted alternative to neostigmine for the reversal of amino-steroidal neuromuscular blocking agents. The aim of this retrospective observational audit was to investigate the impact of this change on clinical practice and associated healthcare costs. Data from all patients intubated during a one-month period in April to May 2010 and for a similar period in 2011 were retrospectively collected and the use of neuromuscular blocking agents and reversal agents were identified and the associated costs were calculated. More steroidal neuromuscular blocking agents and sugammadex (+743%), but less glycopyrrolate and neostigmine (-48%) were used in 2011. Using the manufacturer's list price, muscle relaxation and reversal costs increased from about A$42 per case to about A$127 per case. Between the investigated time periods no differences were found for anaesthesia time, operating time or time spent in the post anaesthesia care unit. However, there was a statistically significant decrease in the time between surgery and discharge (median 2.0 vs 2.2 days). While the design of the audit was such that no inferences can be made about the cause of this change, this is an interesting observation worthy of further investigation.

Introduction of sugammadex as standard reversal agent: Impact on the incidence of residual neuromuscular blockade and postoperative patient outcome

“…This shows a high acceptance rate as an alternative to neostigmine, as previously published by[13] and. [14]…”

Half dose sugammadex combined with neostigmine is non-inferior to full dose sugammadex for reversal of rocuronium-induced deep neuromuscular blockade: a cost-saving strategy

“…Ledowski and colleagues found that the cost of muscle relaxants and reversal increased from 42$ to 127$ per case after the introduction of unrestricted use of sugammadex [20]. Fuchs-Buder and colleagues assessed the feasibility of the routine use of sugammadex for reversal of rocuronium-induced NMB [21].…”

Gestion de la curarisation par rocuronium et sugammadex pour chirurgie abdominale en urgence chez une patiente porteuse d’une myopathie facio-scapulo-humérale

“…Nous proposons la dose de rocuronium de 0,8 mg/ kg qui a permis dans cette observation une intubation rapide, dans d'excellentes conditions, identiques à celles que procure la succinylcholine. La dose de sugammadex en fin d'intervention a é té limité e à 2 mg/kg, ce qui repré sente une diminution inté ressante du coû t de cette anesthé sie, dans un contexte é conomique où l'utilisation même du sugammadex est sujette à controverse [10], notamment du fait du surcoû t qu'elle ne manque pas d'occasionner, et où nous sommes encouragé s à utiliser les molé cules de prix é levé avec parcimonie [11,12]. La place du sugammadex dans ce genre de pathologies paraît né anmoins d'un inté rêt certain tant le gain en termes de sé curité est é vident.…”