• Br J Anaesth · Nov 2010

    Review Meta Analysis Comparative Study

    Sugammadex compared with neostigmine/glycopyrrolate for routine reversal of neuromuscular block: a systematic review and economic evaluation.

    An early review and economic study of the cost effectiveness of sugammadex, concluding that it may be cost effective to routinely reverse with sugammadex if there are significant time savings in the operating theatre, but not if the time savings occur instead in the PACU.

    The study assumed NHS costs of operating room time of £266/h (US$412/h) and PACU time of £20/h (US$31/h).

    summary
    • F Paton, M Paulden, D Chambers, M Heirs, S Duffy, J M Hunter, M Sculpher, and N Woolacott.
    • Centre for Reviews and Dissemination, University of York, Heslington, York YO10 5DD, UK. fcwp500@york.ac.uk
    • Br J Anaesth. 2010 Nov 1;105(5):558-67.

    AbstractThe cost-effectiveness of sugammadex for the routine reversal of muscle relaxation produced by rocuronium or vecuronium in UK practice is uncertain. We performed a systematic review of randomized controlled trials of sugammadex compared with neostigmine/glycopyrrolate and an economic assessment of sugammadex for the reversal of moderate or profound neuromuscular block (NMB) produced by rocuronium or vecuronium. The economic assessment aimed to establish the reduction in recovery time and the 'value of time saved' which would be necessary for sugammadex to be potentially cost-effective compared with existing practice. Three trials indicated that sugammadex 2 mg kg⁻¹ (4 mg kg⁻¹) produces more rapid recovery from moderate (profound) NMB than neostigmine/glycopyrrolate. The economic assessment indicated that if the reductions in recovery time associated with sugammadex in the trials are replicated in routine practice, sugammadex would be cost-effective if those reductions are achieved in the operating theatre (assumed value of staff time, £4.44 per minute), but not if they are achieved in the recovery room (assumed value of staff time, £0.33 per minute). However, there is considerable uncertainty in these results. Sugammadex has the potential to be cost-effective compared with neostigmine/glycopyrrolate for the reversal of rocuronium-induced moderate or profound NMB, provided that the time savings observed in trials can be achieved and put to productive use in clinical practice. Further research is required to evaluate the effects of sugammadex on patient safety, predictability of recovery from NMB, patient outcomes, and efficient use of resources.

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    This article appears in the collection: Is sugammadex as good as we think?.

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    summary
    1

    An early review and economic study of the cost effectiveness of sugammadex, concluding that it may be cost effective to routinely reverse with sugammadex if there are significant time savings in the operating theatre, but not if the time savings occur instead in the PACU.

    The study assumed NHS costs of operating room time of £266/h (US$412/h) and PACU time of £20/h (US$31/h).

    Daniel Jolley  Daniel Jolley
    comment
    0

    The actual cost of both operating theatre and recovery room time in the U.S., Canada, Australia and greater Europe is likely much, much higher than figures used by the researchers. Thus even at its current high cost there is a strong economic argument to be made for using sugammadex for routine reversal.

    However, the opposing point is that the economic benefit is only real if the liberated operating room time can actually be utilised for productive surgical work – this is currently unlikely in many hospitals due to inefficient and inflexible scheduling.

    Daniel Jolley  Daniel Jolley
     
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