Is sugammadex economically viable for routine use

Sugammadex belongs to a new class of drugs termed selective relaxant binding agents and is now available for clinical use in over 50 countries. Because of its innovative mechanism of action, reversal of rocuronium or vecuronium becomes independent of the degree of residual neuromuscular blockade. Deep or intense neuromuscular blockade now can rapidly and predictably be reversed. However, compared with the classical acetylcholine esterase inhibitor-based reversal treatment costs are significantly higher. On the basis of the current literature, the cost-effectiveness of sugammadex will be evaluated.

There is a paucity of evidence-based studies that investigate the pharmacoeconomic aspects of sugammadex reversal. However, several studies assessed the cost-effectiveness of routine reversal with sugammadex compared with cholinesterase inhibitors and one study from the UK analyzed the economic aspects of a rocuronium/sugammadex concept compared with succinylcholine in a 'cannot intubate-cannot ventilate' scenario. The concept of cost reduction by dose reduction of sugammadex is also addressed.

The reduction of recovery times with sugammadex will reduce the incidence of prolonged extubation and may increase patients' throughput. However, the achievable reduction of costs depends on the individual organizational factors, also.