A Retrospective Evaluation of the Cost-effectiveness of Dose Rounding Sugammadex in Pediatric Surgery Patients

Background: To evaluate the cost-effectiveness of a standardized Sugammadex dosing quality improvement project for the pediatric population conducted at Michigan Medicine. Methods: A retrospective chart review of children aged two and older who underwent general anesthesia with endotracheal intubation, received rocuronium or vecuronium as a neuromuscular blocking medication, and received Sugammadex as a reversal agent. The patients received pre-drawn syringes in multiples of 25 mg from the pharmacy or exact mg/kg doses drawn straight from a vial by the anesthesia provider. The primary outcome assessed was the cost of waste for pre- versus post-intervention of the dose rounding project. Results: A total of 5856 patients aged 2 to 17 underwent general anesthesia with endotracheal intubation and received rocuronium or vecuronium as a neuromuscular blocking medication and as the reversal agent. Prior to implementation, the pre-intervention group exhibited waste equal to more than half of the total cost of the medication. Post-intervention waste was eliminated resulting in a significant cost reduction. Conclusion: Following the implementation of the standardized dosing rounding quality improvement project greater than half of the budget spent on Sugammadex for pediatric use was reduced annually. Dose rounding can lead to a more cost-effective method of utilizing Sugammadex in the pediatric population.