Reducing Sugammadex Expenditure through Educational Initiatives in an Urban Tertiary Care Hospital System: A Cost-Reduction Study.

Background: Sugammadex, a selective relaxant binding agent, works by encapsulating rocuronium or vecuronium to reverse neuromuscular blockade. It is an asset in emergencies requiring expedient reversal of neuromuscular blockade, such as situations involving difficult airways. A prevalent concern relating to sugammadex use is its higher cost compared with traditional reversal agents, contributing to more than 20% of operating room drug expenditures at Hamilton Health Sciences (Hamilton, Ontario) in 2019/20. Objective: To use iterative Plan-Do-Study-Act cycles to reduce annual sugammadex expenditure at Hamilton Health Sciences by 50% from costs in the 2020/21 fiscal year. Methods: Five Plan-Do-Study-Act cycles were implemented (January to April 2021) to increase awareness about the cost of sugammadex and appropriate indications for its use. The organization's Department of Pharmacy supplied data regarding acquisition of sugammadex before, during, and after the Plan-Do-Study-Act cycles, which were analyzed quantitatively. A data set regarding difficult airways at Hamilton Health Sciences was analyzed alongside the sugammadex data to aid in understanding the need for accessibility of this drug. Results: Use of sugammadex in fiscal year 2021/22 at Hamilton Health Sciences decreased by 75% from the previous fiscal year, without compromising patient safety or drug availability. Analysis of the difficult airway data revealed that both anticipated and unanticipated cases of difficult airway were still prevalent across all hospitals, which highlights the importance of maintaining access to and knowledge of how to use sugammadex in the setting of difficult airways. Conclusions: This cost-reduction project showed that user-based program designs can have a meaningful impact on resource utilization. Additionally, the difficult airway data set emphasized the clear need to maintain availability of and capabilities for administering sugammadex, given the prevalence of emergency airway situations.