Local identifiability and sensitivity analysis of neuromuscular blockade and depth of hypnosis models

2014 ◽  
Vol 113 (1) ◽  
pp. 23-36 ◽  
Author(s):  
M.M. Silva ◽  
J.M. Lemos ◽  
A. Coito ◽  
B.A. Costa ◽  
T. Wigren ◽  
...  
Keyword(s):  
Sensitivity Analysis ◽  
Neuromuscular Blockade ◽  
Local Identifiability

scholarly journals Economic Impact of Improving Patient Safety Using Sugammadex for Routine Reversal of Neuromuscular Blockade in Spain

2020 ◽  
Author(s):  
Javier Martinez-Ubieto ◽  
Cristian Aragón-Benedí ◽  
José María de Pedro ◽  
Luis Cea ◽  
Alberto Morell Baladron ◽  
...  
Keyword(s):  
Sensitivity Analysis ◽  
Economic Impact ◽  
Neuromuscular Blockade ◽  
Healthcare System ◽  
Drug Acquisition ◽  
Incidence Rates ◽  
Pulmonary Complications ◽  
Decision Analytic Model ◽  
General Anesthetics ◽  
Reversal Agent

Abstract 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 4,806 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 or reversal with neostigmine in the Spanish health care setting.

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

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
J. Martinez-Ubieto ◽  
C. Aragón- Benedí ◽  
J. de Pedro ◽  
L. Cea-Calvo ◽  
A. Morell ◽  
...  
Keyword(s):  
Sensitivity Analysis ◽  
Economic Impact ◽  
Neuromuscular Blockade ◽  
Healthcare System ◽  
Drug Acquisition ◽  
Incidence Rates ◽  
Pulmonary Complications ◽  
Decision Analytic Model ◽  
General Anesthetics ◽  
Reversal Agent

Abstract 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.

scholarly journals Economic analysis of sugammadex versus neostigmine for reversal of neuromuscular blockade for laparoscopic surgery in China

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Maodong Ren ◽  
Ying Wang ◽  
Yan Luo ◽  
Jia Fang ◽  
Yongji Lu ◽  
...  
Keyword(s):  
Sensitivity Analysis ◽  
Laparoscopic Surgery ◽  
Cost Effectiveness ◽  
Neuromuscular Blockade ◽  
Time Horizon ◽  
Medication Cost ◽  
Tree Model ◽  
Residual Neuromuscular Blockade ◽  
Reduced Costs ◽  
The Cost

Abstract Background Neuromuscular blockade and pneumoperitoneum (PP) are important factors to ensure successful laparoscopic surgery. However, residual neuromuscular blockade (rNMB) and PP are associated with many unfavorable complications. The aim of this study is to compare the cost-effectiveness of using sugammadex versus neostigmine in laparoscopic surgery in China. Methods A decision tree model was developed with a time horizon based on laparoscopic surgery related hospitalization duration. 2000 patients using sugammadex or neostigmine were simulated within the model. The model outcomes included incidence of rNMB and PP related complications and their treatment costs. Data on clinical efficacy, safety and cost were collected from published literature and interviews of physicians. Results The model projected that treatment with sugammadex instead of neostigmine would lead to 673 fewer total complications, including rNMB/PP related complications, hospitalization, and other AEs (621 events versus 1294 events, respectively). Use of sugammadex was associated with an incremental medication cost of ¥1,360,410. However, 93.6% of the increased medication cost can be off-set by the reduced costs attributable to treatment of rNMB related complications, PP related complications, hospitalization and other adverse events in sugammadex group. In aggregate, the sugammadex group incurred an incremental cost of ¥86,610 to prevent 673 complications, (¥128.56 per one rNMB/PP related complications prevention). One-way sensitivity analysis confirmed the robustness of the model. Conclusions Use of sugammadex in replacement of neostigmine would result in significantly lower rNMB/PP related complications but at a substantially higher medication cost. Upon accounting for the costs associated with treatment of rNMB/PP related complications, 93.6% of medication cost is projected to be offset. In balance, sugammadex appears to offer good value for reversal of neuromuscular blockade for laparoscopic surgery in China.

scholarly journals Economic Impact of Improving Patient Safety Using Sugammadex for Routine Reversal of Neuromuscular Blockade in Spain

2020 ◽  
Author(s):  
Javier Martinez-Ubieto ◽  
Cristian Aragón-Benedí ◽  
José María de Pedro ◽  
Luis Cea-Calvo ◽  
Alberto Morell Baladron ◽  
...  
Keyword(s):  
Sensitivity Analysis ◽  
Economic Impact ◽  
Neuromuscular Blockade ◽  
Healthcare System ◽  
Drug Acquisition ◽  
Incidence Rates ◽  
Pulmonary Complications ◽  
Decision Analytic Model ◽  
General Anesthetics ◽  
Reversal Agent

Abstract 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 4,806 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 could not be valid for other countries.

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