PSU18 BUDGET IMPACT ANALYSIS OF SUGAMMADEX ON NEUROMUSCULAR BLOCKADE REVERSAL IN COLOMBIA

Abstract

To estimate the country-level budget impact of sugammadex on neuromuscular blockade reversal under the Colombian third-party payer perspective. A budget impact model was used for the estimation of blockade reversal and adverse events costs of patients who underwent a major surgery requiring moderate neuromuscular blockade (with rocuronium or vecuronium) reversed with sugammadex or neostigmine/atropin. The time horizon was set to 1 year and the study perspective was the Colombian third-party payer (Health Care System). Country-level target population was obtained from the Colombian Individual Registry of Health Benefits (RIPS in Spanish) database using the following filters pre-defined according to an expert consultation: procedures requiring endotracheal intubation, cardiovascular, abdominal and laparoscopic procedures. Similarly, expert consultation was carried out to identify the cost-generating events for every adverse event. Atelectasis, pneumonia and hospital re-admission were considered, and their cost was weighted by the risk of occurrence with each alternative. Medication cost was obtained from a local drug price public database (SISMED) and procedures and hospitalization costs were estimated using local tariff manuals (ISS and SOAT). Assuming that sugammadex totally supersedes neostigmine/atropine utilization in moderate neuromuscular blockade reversal, it represents an initial investment of 15,808,074 USD (1 USD = 2,857.98 COP) and net savings of 6,010,479 USD at the end of the time horizon. The savings are mainly related to the decrease on the appearance rate of the adverse effects. Sensitivity analyses are consistent with the base case, re-hospitalization cost and risk are the variables that may affect the direction of the results. The replacement of neostigminie/atropine by sugammadex in moderate neuromuscular blockade reversal is likely to have a positive impact on a budgetary level, under the Colombian third-party payer perspective. The initial expenditure in sugammadex acquisition is offset by the costs from avoided adverse events