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Evidence-based Practice and Quality Improvement

Sugammadex: a novel approach to controlling spiralling drug costs


Bramma, Y. L.; Alcorn, D.

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European Journal of Anaesthesiology (EJA): June 2013 - Volume 30 - Issue - p 25-25
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Background and Goal of Study: While the use of Sugammadex in Scotland is officially restricted to the immediate reversal of rocuronium-induced neuromuscular blockade following RSI, increasing clinical experience has demonstrated a place for reversal with Sugammadex in many other situations. This has lead to an increase in its use and a subsequent increase in the cost of the drug to health boards.

As a result of pressure from our health board to reduce these costs, we have audited the use of Sugammadex within our department for one year and have adapted our prescribing policy in order to minimize cost.

Materials and Methods: Our hospital has 9 in-patient, 2 day surgery, and 2 obstetric operating theatres. Sugammadex was initially freely available in 500mg/5ml vials in theatre until the 200mg vials in Nov 2011became available and were used for routine reversal. Each vial was treated like a controlled drug and had to be “signed out” by two members of staff (anaesthetist and nurse). No restrictions were placed on the indications for use other than an audit form had to be completed giving the reason for its use in each particular case. These forms were discussed three-monthly at our departmental audit meetings.

Information on drug expenditure was obtained from our hospital pharmacy.

Results and Discussion: Results are for the 18-month period between April 2011 and end of Sept 2012. The audit was commenced in Nov 2011. Cost data is split into 6-month periods for the two sizes of vial available, as shown in Table 1.

[Table 1 - Departmental expenditure on Sugammadex]

Since the audit started, there has been a 55% reduction in the cost of sugammadex to our department. Across all sites in our health board, this would equate to a saving of nearly £22,000.

Conclusion(s): By making Sugammadex a controlled drug and auditing its use, we have halved our costs. Anaesthetists can still use the drug freely but the process of signing it out and justifying this decision ensures that the use of Sugammadex is restricted to those patients who would benefit most. This is a relatively simple way to control the costs of Sugammadex that could be applied to all anaesthetic departments.

© 2013 European Society of Anaesthesiology