Sugammadex aliquot pilot project in adults having elective surgical procedures - A pharmacoeconomic retrospective deidentified chart review to improve quality and cost of anesthesia care.

INTRODUCTION: Sugammadex is highly effective in reversing neuromuscular block, but costly and not without known complications. Subjectively determined empiric dosing of sugammadex for routine antagonism of neuromuscular block risks over- or under-dosing patients and leads to increases in drug acquisition costs, especially in markets where generics remain unavailable. We hypothesized that our recently implemented sugammadex aliquoting policy and its administration guided by quantitative neuromuscular monitoring would lower the cost of empirically dosed sugammadex antagonism. This retrospective analysis of 524 patients evaluated the pharmacoeconomic impact of sugammadex aliquoting and administration guided by quantitative neuromuscular monitoring versus subjectively determined routine antagonism of neuromuscular block in adults having elective surgical procedures.

METHODS: This single-center retrospective deidentified chart review included adult patients having elective surgical procedures requiring general anesthesia. Cost of sugammadex ($129.05/200-mg vial) antagonism was based on the assumed routine administration of 1 vial. When using sugammadex aliquots (50 mg/0.5 mL), the dose saved was calculated as 200 mg minus total aliquots used. Gross cost savings per patient were determined by subtracting cost (labor, supplies, drug acquisition) of individual aliquots from actual sugammadex vials acquisition cost. Using neostigmine ($1.99/10 mg vial) and glycopyrrolate ($1.74/0.4 mg vial), the total per-case cost was determined by the number of full vials administered. Actual net cost savings/case included sensor cost ($20.00) and hardware cost ($1995/monitor amortized over 7 years) from gross savings per surgical case.

RESULTS: In patients receiving sugammadex aliquots (n = 258), the mean gross cost was $51.50 (mean gross savings, $77.55/case vs. full-vial). Neostigmine/glycopyrrolate (n = 111) mean gross cost, $4.39/case. Patients managed without pharmacological reversal (n = 63) incurred no drug costs (savings of 200-mg sugammadex vial, $129.05). For all patients, mean gross (drugs only) and net (including monitoring) costs per case were markedly lower with aliquoting ($51.50 and $71.66, respectively) compared with full-vial use ($129.05 and $149.21, respectively). Aliquoting yielded total hospital net savings (including quantitative monitoring) of $20,008.

CONCLUSION: Aliquoting and dosing sugammadex guided by quantitative neuromuscular monitoring in this single center reduces annual drug acquisition costs and produces consistent savings across dose ranges.