Sugammadex and Neostigmine reverse neuromuscular blockade post-surgery. Sugammadex selectively reverses
steroidal neuromuscular blockers like rocuronium while neostigmine, an anticholinesterase, prevents the breakdown
of acetylcholine at the neuromuscular junction. Sugammadex has faster recovery times, is more predictable,
and has fewer side effects, but is costlier. This reduces post-surgery complications and unexpected hospital stays.
This literature review investigated Sugammadex’s cost-effectiveness at the institutional level, considering factors
like patient risk, recovery time, OR costs, and adverse events. The review included studies published in the last
10 years discussing potential financial benefits despite the increased cost. Searches were conducted in PubMed,
Open Evidence, and UpToDate using keywords like “sugammadex,” “neostigmine,” “cost-effectiveness,” “speed,”
“efficacy,” and “drug pricing.” Studies lacking a possible cost savings benefit, side effects, and speed and efficacy
of sugammadex compared to neostigmine were excluded. Key findings indicate that Sugammadex can have cost
savings potential with high-volume institutions that manage time efficiently. Sugammadex’s predictability decreases
possible employee overtime costs and can be adjusted for body weight, causing a possible decrease in cost per
patient. In low-risk patients, it was more cost-effective, but in high-risk patients, neostigmine was preferable due to
cost concerns. Sugammadex can lead to decreased cost for institutions if it is used strategically to optimize its speed
and efficacy, despite its increased cost compared to neostigmine. Further research is needed to verify other factors
like time to recovery, operating room costs, and adverse events.
