Using continuous quantitative capnography for emergency department procedural sedation: a systematic review and...

Area of Science:

• Emergency Medicine
• Health Economics
• Patient Safety

Background:

• Continuous waveform quantitative end-tidal CO2 monitoring is proposed to enhance emergency department (ED) procedural sedation safety.
• This monitoring aims to reduce hypoxia and catastrophic outcomes during sedation procedures.

Purpose of the Study:

• To evaluate the cost-effectiveness of routine continuous waveform quantitative end-tidal CO2 monitoring for ED procedural sedation.
• To estimate the societal costs associated with preventing catastrophic events (death or hypoxic brain injury).

Main Methods:

• Markov modeling was employed for cost-effectiveness analysis.
• Data on capnography efficacy and sedation safety were sourced from existing literature.
• The model was applied to all US ED procedural sedations, optimizing for efficacy and minimizing implementation costs.

Main Results:

• Routine capnography use could decrease the 5-year catastrophic adverse event rate from 15.5 to 9.2 events in US EDs.
• The estimated cost is $2,830,326 per prevented catastrophic event over 5 years.
• This equates to $114,007 per quality-adjusted life-year, with sensitivity analyses confirming high costs.

Conclusions:

• Continuous waveform quantitative end-tidal CO2 monitoring is a highly costly approach for preventing catastrophic complications during routine ED procedural sedation.
• The significant cost per event prevented suggests limited cost-effectiveness for widespread routine implementation.