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Melatonin and Triclofos Sodium to Execute Sleep Electroencephalography in Pediatric Patients: A Cost-Effectiveness
Harsimran Kaur1, Kavita Srivastava2, Suparna Karmakar1
1Department of Clinical Pharmacy, Poona College of Pharmacy, Bharati Vidyapeeth (Deemed to Be University), Pune, Maharashtra, 411038, India.
Insights
Melatonin is more cost-effective than triclofos for pediatric sleep electroencephalography (EEG). This study suggests institutions consider resource-based costing for efficient allocation of healthcare resources.
Area of Science:
- Pediatric Neurology
- Pharmacoeconomics
- Clinical Diagnostics
Background:
- Sleep electroencephalography (EEG) is crucial for diagnosing pediatric neurological conditions.
- Oral sedatives are often necessary to facilitate sleep EEG in pediatric patients.
- Evaluating the cost-effectiveness of different sedatives is essential for healthcare resource allocation.
Purpose of the Study:
- To compare the cost-effectiveness of melatonin versus triclofos sodium for pediatric sleep EEG.
- To establish criteria for institutional resource allocation based on sedative efficacy and cost.
Main Methods:
- A prospective randomized controlled trial involving 228 pediatric patients undergoing sleep EEG.
- Patients were randomized to receive either melatonin or triclofos sodium at specified dosages.
- Cost-effectiveness analysis was conducted from the healthcare institution's perspective, using successful and abnormal EEG as outcomes.
Main Results:
- Both melatonin and triclofos achieved high rates of successful EEG (89.4% vs. 91.2%) and abnormal EEG detection (49% vs. 42.3%), with no significant difference (p > 0.05).
- The total direct cost was significantly lower for melatonin (INR 1881.75) compared to triclofos (INR 2772.5) (p < 0.05).
- Cost-effectiveness ratios per successful EEG were INR 18.45 for melatonin and INR 26.66 for triclofos; per abnormal EEG, they were INR 37.64 and INR 63.01, respectively.
Conclusions:
- Melatonin demonstrates superior cost-effectiveness compared to triclofos sodium for pediatric sleep EEG when costs are based on individual dosage.
- Healthcare institutions should consider implementing resource-utilization-based costing systems.
- This approach can lead to more effective allocation of institutional resources in pediatric diagnostic procedures.
Objectives:
To evaluate cost-effectiveness between oral sedatives melatonin and triclofos sodium used to perform sleep electroencephalography (EEG) in pediatric patients and develop a criterion for resource allocation by the institution.
Methods:
This prospective study was conducted alongside the randomized controlled trial conducted at a tertiary care hospital, wherein pediatric patients arriving for sleep EEG were randomized to receive melatonin dosed at 0.3 mg/kg (< 10 kg), 3 mg (10-15 kg), and 6 mg (> 15 kg) and triclofos at 50 mg/kg (maximum dose 1 g, 6 mo to 11 y; 2 g, 11 to 18 y) after due consent. The cost-effectiveness analysis was performed from the healthcare institution's perspective. Successful EEG and abnormal EEG were the effectiveness parameters.
Results:
Two hundred twenty-eight patients were divided equally between two groups. Melatonin (N = 114) and triclofos (N = 114) recorded successful EEG in 89.4% and 91.2% patients and abnormal EEG in 49% and 42.3% patients, respectively (p > 0.05). The total direct cost incurred was INR 1881.75 (USD 26.6) and INR 2772.5 (USD 39.2) for melatonin and triclofos, respectively (p < 0.05). The cost-effectiveness ratio-1 (CER-1) for melatonin and triclofos per successful EEG recorded was INR 18.45 (USD 0.39) and INR 26.66 (USD 0.58), respectively. The CER-2 for melatonin and triclofos per abnormal EEG detected was INR 37.64 (USD 0.53) and INR 63.01 (USD 0.89), respectively.
Conclusions:
Melatonin is more cost-effective than triclofos when charged based on individual dose requirements. Hospitals, diagnostic centers, healthcare institutions may consider resource-utilization-based costing system for cost-effective allocation of resources.
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