Economic impact of improving patient safety using Sugammadex for routine reversal of neuromuscular blockade in Spain

Background

Neuromuscular blocking (NMB) agents are often administered to facilitate tracheal intubation and prevent patient movement during surgical procedures requiring the use of general anesthetics. Incomplete reversal of NMB, can lead to residual NMB, which can increase the risk of post-operative pulmonary complications. Sugammadex is indicated to reverse neuromuscular blockade induced by rocuronium or vecuronium in adults. The aim of this study is to estimate the clinical and economic impact of introducing sugammadex to routine reversal of neuromuscular blockade (NMB) with rocuronium in Spain.

Methods

A decision analytic model was constructed reflecting a set of procedures using rocuronium that resulted in moderate or deep NMB at the end of the procedure. Two scenarios were considered for 537,931 procedures using NMB agents in Spain in 2015: a scenario without sugammadex versus a scenario with sugammadex. Comparators included neostigmine (plus glycopyrrolate) and no reversal agent. The total costs for the healthcare system were estimated from the net of costs of reversal agents and overall cost offsets via reduction in postoperative pneumonias and atelectasis for which incidence rates were based on a Spanish real-world evidence (RWE) study. The model time horizon was assumed to be one year. Costs were expressed in 2019 euros (€) and estimated from the perspective of a healthcare system. One-way sensitivity analysis was carried out by varying each parameter included in the model within a range of +/− 50%.

Results

The estimated budget impact of the introduction of sugammadex to the routine reversal of neuromuscular blockade in Spanish hospitals was a net saving of €57.1 million annually. An increase in drug acquisition costs was offset by savings in post-operative pulmonary events, including 4806 post-operative pneumonias and 13,996 cases of atelectasis. The total cost of complications avoided was €70.4 million. All parameters included in the model were tested in sensitivity analysis and were favorable to the scenario with sugammadex.

Conclusions

This economic analysis shows that sugammadex can potentially lead to cost savings for the reversal of rocuronium-induced moderate or profound NMB compared to no reversal and reversal with neostigmine in the Spanish health care setting. The economic model was based on data obtained from Spain and from assumptions from clinical practice and may not be valid for other countries.

[Prevalence of vascular risk factors among Spanish populations aged 70 years and over, as reported in door-to-door studies on neurological diseases]

INTRODUCTION

The aim of this study was to re-analyze door-to-door studies on neurological diseases among the elderly, in which vascular risk factors (VRF) were studied, describing methodological characteristics and prevalence of VRF.

METHODS

The surveys were identified in two phases. They were aimed at ascertaining prevalence of stroke, dementias or Parkinsonisms and, at the time of individual screening, had collected data on at least three of the following VRF: arterial hypertension (AHT), smoking habit, diabetes mellitus and hypercholesterolemia. A questionnaire was drawn up to collect the data reported in each study, and a database was constructed. VRF prevalences were quantified and analyzed using logistic regression.

RESULTS

The total of the re-analyzed population was 12,510 persons aged 70 years and over, residents in seven geographic areas during the period 1994-2002. Information available on VRF was essentially self-reported. The prevalence of self-reported AHT was 25.7 % in men and 44.2 % in women, and that of measured AHT was 61 % and 71.9 %, respectively. Populations with arterial pressure obtained by direct measurement registered 138 higher risks (OR: 1.74; 95 % CI: 1.51-2.01, and OR: 1.48; 95% CI: 1.33-1.64). Reported prevalence of diabetes, hypercholesterolemia and smoking habit were 14.3 %, 23.3% and 8.5 %, respectively.

CONCLUSIONS

There was a high prevalence of VRF among the Spanish elderly population. However, its relationship with dementia, Parkinsonisms and cerebrovascular disease could not be studied due to the poor quality of the VRF data. The differences between measured and self-reported arterial pressure suggest the existence of undetected AHT and wide scope for prevention.

Quality of life of caregivers in Parkinson?s disease

OBJECTIVE

To assess the impact of PD on informal caregivers of patients and identify the main factors related to caregiver strain.

PATIENTS AND METHODS

Pairs of PD patients and their caregivers. Evaluation by neurologists included the Hoehn and Yahr, Schwab and England, UPDRS (parts 1-3), ISAPD, and Pfeiffer's SPMSQ rating scales. Patients completed the Euro-QoL 5D, PDQ-8, and Hospital Anxiety and Depression Scale. The SQLC was used to assess caregivers' quality of life (QoL), with caregivers, in turn, applying the Euro-QoL and PDQ-8 to assess patients' health-related quality of life (HRQoL). Multiple linear regression models were fitted to ascertain factors linked to the SQLC.

RESULTS

Significant correlations were in evidence between the following scores: SQLC and clinical rating scales and SQLC and patients' HRQoL. Based on multiple regression analysis, patients' functional state (ADL) proved to be the main predictor of caregivers' QoL. Self- and caregiver-assessed patients' HRQoL also proved to be a relevant factor.

CONCLUSIONS

(1) Patients' functional state was significantly related to caregivers' psychosocial burden; (2) patients' HRQoL proved to be an additional factor linked to caregiver QoL; (3) improvement of patient disability and HRQoL might alleviate caregiver strain.

Tracers for paralysis agitans in epidemiological research. V. Prevalence of the disease in Swedish counties

The prevalence of parkinsonism varies severalfold between different countries in the world. This could be due to an accumulation of risk factors in certain areas. In the present paper we have analyzed the regional distribution of parkinsonism in Sweden in order to see if such areas could be found within one country. The study was based on sales of levodopa in the different counties of Sweden, and the results were standardized for age and quality of health services as indicated by the local infant mortality rates. The mean prevalence of the different Swedish counties was estimated to be in the middle range of known prevalences. There was a 60% variation within Sweden between the different counties, but the regional distribution did not show a systematic pattern. Further analysis of the causes for this variation showed that differences in case ascertainment and in drug policy could well account for the observed regional differences in parkinsonism prevalence.

Tracers for paralysis agitans in epidemiological research. IV. Trends in national drug policy and measurement of the prevalence of the disease in Sweden

This study is a time series analysis of the utilization of L-dopa derivatives (LDD) and bromocriptine by parkinsonism (PA) patients and of the age-specific PA prevalences estimated by using a previously reported model. The model combines information on LDD sales, infant mortality rates (IMR) and demographic data for Sweden during the period 1974-1984. Valid yearly prevalence estimates were obtained since 1980 when the early increments of LDD sales were less than 7.9% and the early introduction of bromocriptine in the treatment of PA had already occurred. The crude PA prevalence calculated for 1984 was 254.8 per 100,000. The precision of the estimates during the period 1980-1984 was 2.6%. The model monitored the age-specific prevalence of PA in Sweden during that period, giving increasing figures for the age group 70 years and older, and was not especially sensitive to any particular type of inaccurate input. Time trend analyses of yearly estimates for populations higher than 100,000 individuals and of LDD diffusion are recommended when using this model.

Tracers for paralysis agitans in epidemiological research. III. Refinement of the model for estimation of the prevalence of the disease

The study presents a refinement of a preliminary model for estimation of the prevalence of Parkinson's disease (PA) from information on sales of L-dopa derivatives (LDD) and demographic data. The new model made use of a set of age-specific equations describing PA prevalences obtained from historical surveys and local infant mortality rates (IMR). This strategy made it possible to obtain age-specific estimates of PA prevalence and adjust for differences in health services quality. The new model was tested using data from Sardinia and Iceland. The results are in agreement with the field surveys. When the model was tested in Sweden in 1983-1984 using data on age-specific consumption of LDD, the results also validated the model. The new refined model was found to be useful for estimation of age-specific prevalence from available data on total sales of LDD, the population and infant mortality rates.