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Cost-effectiveness analysis of clinic-based chloral hydrate sedation versus general anaesthesia for paediatric
Heather F Burnett1, Rosemary Lambley2, Stephanie K West3
1Program of Child Health Evaluative Sciences, The Hospital for Sick Children Peter Gilgan Centre for Research and Learning, Toronto, Ontario, Canada.
Insights
Paediatric eye exams in an outpatient sedation unit are more cost-effective than those under general anaesthesia. While slightly fewer procedures were completed, significant savings were observed, making it a valuable alternative for children
Area of Science:
- Ophthalmology
- Health Economics
- Pediatrics
Background:
- Detailed pediatric eye examinations often require general anesthesia (GA) due to patient intolerance.
- Assessing cost-effectiveness is crucial for optimizing healthcare resource allocation in pediatric eye care.
Purpose of the Study:
- To evaluate the incremental cost-effectiveness of pediatric eye examinations performed in an outpatient sedation unit versus general anesthesia.
- To compare the costs, adverse events, and success rates of two distinct examination settings.
Main Methods:
- A societal perspective cost-effectiveness analysis was performed.
- A retrospective cross-over cohort design included Canadian children under 7 years old.
- Decision analysis modeled costs, adverse events, and successful procedures with sensitivity analyses.
Main Results:
- Examinations under sedation (EUS) cost $406 per patient, while examinations under anesthesia (EUA) cost $1135.
- EUS yielded 1.39 successful procedures per patient, compared to 2.06 for EUA.
- EUA was $729 more expensive but resulted in 0.68 more successful procedures per child.
Conclusions:
- Cross-over designs are effective for comparing intervention costs and effectiveness.
- Pediatric ophthalmological exams in hospital outpatient clinics offer significant cost savings.
- Outpatient sedation provides a cost-effective alternative to general anesthesia for pediatric eye examinations, despite a potential slight decrease in completed procedures.
Background/Aims:
The inability of some children to tolerate detailed eye examinations often necessitates general anaesthesia (GA). The objective was to assess the incremental cost effectiveness of paediatric eye examinations carried out in an outpatient sedation unit compared with GA.
Methods:
An episode of care cost-effectiveness analysis was conducted from a societal perspective. Model inputs were based on a retrospective cross-over cohort of Canadian children aged <7 years who had both an examination under sedation (EUS) and examination under anaesthesia (EUA) within an 8-month period. Costs ($CAN), adverse events and number of successful procedures were modelled in a decision analysis with one-way and probabilistic sensitivity analysis.
Results:
The mean cost per patient was $406 (95% CI $401 to $411) for EUS and $1135 (95% CI $1125 to $1145) for EUA. The mean number of successful procedures per patient was 1.39 (95% CI 1.34 to 1.42) for EUS and 2.06 (95% CI 2.02 to 2.11) for EUA. EUA was $729 more costly on average than EUS (95% CI $719 to $738) but resulted in an additional 0.68 successful procedures per child. The result was robust to varying the cost assumptions.
Conclusions:
Cross-over designs offer a powerful way to assess costs and effectiveness of two interventions because patients serve as their own control. This study demonstrated significant savings when ophthalmological exams were carried out in a hospital outpatient clinic, although with slightly fewer procedures completed.
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