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GM-010 Sugammadex compared with suxamethonium/neostigmine/atropine for routine reversal of neuromuscular block in bariatric surgery: What’s the budget impact?
  1. M Grande1,
  2. J Descout2,
  3. V Kouyoumdjian2,
  4. R Gervais1,
  5. MM Talbert1,
  6. D Verriere3,
  7. M Pellerin3
  1. 1Hopital de Saint Denis, Pharmacy, Saint Denis, France
  2. 2Faculté de Pharmacie Université Paris Descartes, Pharmacy, Paris, France
  3. 3Hopital de Saint Denis, Anesthesy, Saint Denis, France

Abstract

Background There is lack of consensus from clinical experts regarding the place of sugammadex in treatment. However, most consider that sugammadex may be useful when there is a clinical safety concern or when reversal of profound neuromuscular block is required (obese patients). Due to these potential clinical benefits, the anaesthesia staff have changed the existing protocol in bariatric surgery from suxamethonium, atracurium and neostigmine + atropine, to rocuronium + sugammadex.

Purpose To predict the potential financial impact of introducing sugammadex in bariatric surgery on the hospital’s limited annual budget.

Materials and methods The analysis compared the baseline scenario with the new scenario. The evaluation was conducted from the hospital’s perspective. The target population was patients who benefit from sleeve gastrectomy. We selected a retrospective cohort of 28 patients for the baseline scenario, and a prospective cohort of 29 patients for the new one. Direct pharmacological costs in euro were considered. The prices of each vial of drugs were taken from public purchasers and the total number of vials used was searched in the patient’s record.

Results The incremental impact on the hospital’s budget was estimated to be 187 €/patient. The Department of Medical Information estimated the population eligible for treatment to be 237 in year 1 rising to 310 in year 2, with an estimated uptake rate of 30%. The incremental budget impact for the hospital is 51,238 € during the first year and 66,609 € during the second. This additional cost must be linked to the average perceived price by the hospital for bariatric surgery (4.6% of the amount allocated). We also conducted a clinical study, and the time spent in the post-anaesthesia care unit decreased by 30 min per patient making it possible to rotate patients more efficiently in the unit.

Conclusions The high budgetary impact of moving to a baseline scenario of rocuronium/sugammadex supports the idea that this therapeutic strategy must be limited to obese patients. Ultimately, purchase negotiations could bring down the cost of sugammadex.

No conflict of interest.

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