title: Sugammadex for reversal of neuromuscular blockade: a retrospective analysis of clinical outcomes and cost-effectiveness in a single center.
abstract: OBJECTIVE
  The aim of the study is to evaluate the clinical and economic impact of introducing a rocuronium-neostigmine-sugammadex strategy into a cisatracurium-neostigmine regimen for neuromuscular block (NMB) management.
  
  
  METHODS
  We conducted a retrospective analysis of clinical outcomes and cost-effectiveness in five operating rooms at University Hospital of Padova. A clinical outcome evaluation after sugammadex administration as first-choice reversal drug in selected patients (rocuronium-sugammadex) and as rescue therapy after neostigmine reversal (rocuronium-neostigmine-sugammadex) compared to control was performed. A cost-analysis of NMB management accompanying the introduction of a rocuronium-neostigmine-sugammadex strategy into a cisatracurium-neostigmine regimen was carried out. To such purpose, two periods were compared: 2011-2012, without sugammadex available; 2013-2014, with sugammadex available. A subsequent analysis was performed to evaluate if sugammadex replacing neostigmine as first choice reversal drug is cost-effective.
  
  
  RESULTS
  The introduction of a rocuronium-neostigmine-sugammadex strategy into a cisatracurium-neostigmine regimen reduced the average cost of NMB management by 36%, from €20.8/case to €13.3/case. Patients receiving sugammadex as a first-choice reversal drug (3%) exhibited significantly better train-of-four ratios at extubation (P<0.001) and were discharged to the surgical ward (P<0.001) more rapidly than controls. The cost-saving of sugammadex as first-choice reversal drug has been estimated to be €2.9/case. Patients receiving sugammadex as rescue therapy after neostigmine reversal (3.2%) showed no difference in time to discharge to the surgical ward (P=0.44) compared to controls. No unplanned intensive care unit (ICU) admissions with rocuronium-neostigmine-sugammadex strategy were observed. The potential economic benefit in avoiding postoperative residual curarization (PORC)-related ICU admission in the 2013-2014 period was estimated at an average value of €13,548 (€9,316-€23,845).
  
  
  CONCLUSIONS
  Sugammadex eliminated PORC and associated morbidities. In our center, sugammadex reduced the costs of NMB management and promoted rapid turnover of patients in operating rooms, with total cost-effectiveness that counteracts the disadvantages of its high cost.
authors.affiliation: Department of Medicine, Anesthesiology and Intensive Care, University of Padova, Padova, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Carron
authors.affiliation: Department of Medicine, Anesthesiology and Intensive Care, University of Padova, Padova, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Baratto
authors.affiliation: Department of Medicine, Anesthesiology and Intensive Care, University of Padova, Padova, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Zarantonello
authors.affiliation: Department of Medicine, Anesthesiology and Intensive Care, University of Padova, Padova, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Ori
keywords: cost-benefit analysis; neuromuscular blockade; neuromuscular blocking agents; postoperative residual curarization; rocuronium; sugammadex