Racial and Ethnic Disparities in the Use of Expensive Medications: A Focus on Sugammadex in the Pediatric Perioperative Setting.

introductionAvoiding residual neuromuscular blockade in the postoperative period sparked interest in the use of sugammadex as a reversal agent. However, because sugammadex was considered more expensive than other commonly used medications for this purpose, it was crucial to investigate potential disparities in its use.

methodsA retrospective cohort study of children (<18 years) was performed, who underwent general anesthesia and received neuromuscular blockade, in hospitals reporting to the Pediatric Health Information System between January 1, 2018, and December 31, 2023 was performed. Multivariable log-binomial regression was used to estimate the adjusted relative risk (RRAdj) of sugammadex administration across racial and ethnic groups, while adjusting for baseline covariates.

resultsThe study included 246,171 children. The overall use of sugammadex steadily increased among all groups throughout the study period from 2018 to 2023. The adjusted rate of sugammadex administration trended consistently lower for Black children compared with White children throughout the study period (54.5% vs 62.7%, RRAdj: 0.86 [95% CI, 0.84-0.87]), p < 0.01). A less pronounced lower rate of receiving sugammadex was noted for Hispanic children compared with White children (60.7% vs 62.7%, RRAdj 0.97 [95% CI, 0.95-0.98], p < 0.01). Asian children were also less likely to receive sugammadex, compared with White children (58.7% vs 62.7%, RRAdj 0.94 [95% CI, 0.91-0.96], p < 0.01). Within insurance group comparisons mirrored the disparities observed in the main model.

conclusionsDespite increased use of sugammadex among children who underwent elective surgery, racial and ethnic disparities in its use remained. These differences persisted regardless of insurance status.