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Comparing the Costs Associated with Anxiolytic Agents for Reducing Distress in Children Undergoing Laceration Repair
Nam-Anh Tran1, Yi-Shu Lin2, Petros Pechlivanoglou2,3
1Department of Epidemiology, Biostatistics and Occupational Health, School of Population and Global Health, McGill University, Montreal, Quebec, Canada.
Insights
Intranasal midazolam (INM) offers the lowest cost for pediatric laceration repair, while nitrous oxide (N2O) provides the shortest procedure length. Further research is needed to clarify optimal medication choices for children.
Area of Science:
- Pediatric Emergency Medicine
- Pharmacology
- Health Economics
Background:
- Procedural medications for anxiolysis in children undergoing laceration repair can reduce distress and restraint.
- The optimal medication choice for pediatric emergency departments remains unclear.
- This study evaluates length of stay (LOS) and costs for four procedural medications.
Purpose of the Study:
- To compare hospital length of stay (LOS) and healthcare costs for four procedural medications used in pediatric laceration repair.
- To analyze the economic impact from the perspective of the Canadian healthcare system.
- To identify key drivers of uncertainty in medication choice.
Main Methods:
- An individual-level state-transition model compared intranasal midazolam (INM), inhaled nitrous oxide (N2O), intranasal dexmedetomidine, and intravenous ketamine (IVK).
- Model inputs were derived from literature and expert consultations.
- LOS and healthcare costs (personnel, equipment, medication) were analyzed, with uncertainty assessed using the TRUST tool.
Main Results:
- Estimated LOS: N2O (78.34 min), INM (82.13 min), IVK (103.37 min), intranasal dexmedetomidine (114.55 min).
- Estimated per-person costs: INM ($122.79), IVK ($167.16), intranasal dexmedetomidine ($165.07), N2O ($176.70).
- Decision uncertainty was primarily linked to procedure time for N2O and IVK, with limited evidence quality.
Conclusions:
- Intranasal midazolam (INM) demonstrated the lowest expected healthcare cost.
- Inhaled nitrous oxide (N2O) was associated with the shortest expected length of stay.
- Further research is needed on procedure length with N2O and IVK to reduce decision uncertainty.
Objectives:
The use of procedural medications for anxiolysis during laceration repair in children can mitigate distress, facilitate procedures, and avoid physical restraint. However, the optimal medication for use in the pediatric emergency department is unclear. This study compares hospital length of stay (LOS) and costs for 4 different procedural medications for pediatric laceration repair from the perspective of the Canadian health care system.
Methods:
We used an individual-level state-transition model to compare (i) intranasal midazolam (INM), (ii) inhaled nitrous oxide (N2O), (iii) intranasal dexmedetomidine, and (iv) intravenous ketamine (IVK). Model inputs were informed by literature and expert consultations. LOS included time before, during, and after laceration repair, adjusting for adequacy of interventions and adverse events. Healthcare costs included personnel, equipment, and medication costs. We evaluated the drivers of model uncertainty using the TRansparent Uncertainty aSsessmenT (TRUST) tool and value of information analyses.
Results:
The estimated LOS for N2O, INM, IVK, and intranasal dexmedetomidine were 78.34, 82.13, 103.37, and 114.55 minutes with the per-person estimated costs of $176.7, $122.79, $167.16, and $165.07, respectively. These results were limited by the low quality of available evidence for model inputs. The key parameters contributing to decision uncertainty were procedure time for N2O and IVK, with an expected value of $5.31 and $0.44 per person, respectively.
Conclusion:
INM had the lowest expected healthcare cost, whereas children receiving N2O had the shortest expected LOS. Decision uncertainty was driven by the lack of relevant studies examining the length of procedure with N2O and IVK use.
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