Patent expiry of sugammadex associated with increased use and significant cost savings

Background

Sugammadex is a selective relaxant binding agent used by anaesthetists to reverse the effects of rocuronium and vecuronium which are used to facilitate muscle relaxation during surgery. Sugammadex is associated with a quicker reversal and less autonomic side effects than the standard combination of neostigmine with an antimuscarinic; however, sugammadex is markedly more expensive. In June 2023, the patent for sugammadex expired and subsequently the cost reduced significantly.

Objectives

This study aimed to identify the implication of the sugammadex patent change on local practice by:

1. Examining the number of supplies of sugammadex made from hospital stores over a one-year period
2. Calculating the average monthly spend on sugammadex before and after patent expiry
3. Gathering anaesthetists’ opinions on sugammadex’s efficacy and patent expiry.

Method

The hospital’s electronic stock system was used to gather cost information and issue history of sugammadex. The data was collected retrospectively from February 2023 to February 2024. An online questionnaire was distributed in March 2024 to consultant anaesthetists and specialty doctors to capture their views on the changes.

Results

Interrupted time series analysis showed a 36.5% increase in the monthly supply of all sugammadex products across the one-year period. This increase is higher than the 15-25% predicted based on the contracted supply estimation.

Calculating monthly expenditure on sugammadex whilst under patent shows an average monthly cost of £18,130 to the health board. The average monthly cost since sugammadex came off patent was £2,103, leading to an annual cost saving of around £192,325. Despite the decrease in overall price, it is still regarded as more expensive than neostigmine.

A 44% (22/50) questionnaire response rate was achieved. Anaesthetists expressed they felt sugammadex had a superior effect to neostigmine (with an antimuscarinic). The price decrease meant anaesthetists were more relaxed around the patients who met the criteria for sugammadex use. Despite this, anaesthetists stated that neostigmine alongside an antimuscarinic drug remains standard practice. Sugammadex continues to be largely restricted to higher risk individuals.

Conclusion

Sugammadex’s place in therapy remains largely the same, with use reserved primarily for higher risk patients, as noted by anaesthetists. However, a considerable increase in the quantity of sugammadex supplied within the hospital suggests local practice has in fact changed. Significant cost savings have been identified since the patent expired.

The patent for sugammadex expiring increased demand UK wide, resulting in shortages, primarily of the 200mg/2mL ampoules. Subsequently, this increased the use of 500mg/5mL ampoules which are more expensive and may have affected overall usage. Prior to this, 500mg/5mL ampoules were rarely used (typically reserved for emergencies).

Therefore, the costs outlined above may not reflect the costs going forward now that the shortages have resolved, and availability of the smaller ampoules may lead to additional cost savings on top of those already identified. These results were gathered from one hospital, in one health board, and may not be representative of other areas.

Additional authors: Breige Smyth & Alan Timmins, Victoria Hospital, NHS Fife

The opinions expressed in this article are those of the author. They do not purport to reflect the opinions or views of the UKCPA or its members. We encourage readers to follow links and references to primary research papers and guidance.

Competing interest statement:

The author declares: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.