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Cost-effectiveness analysis of sedation regimens for children undergoing magnetic resonance imaging in Japan: a
Soichiro Obara1, Yoshinori Nakata2
1Teikyo University Graduate School of Public Health, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-8605, Japan. obara.souichirou.bv@teikyo-u.ac.jp.
Insights
Propofol sedation is the most cost-effective for pediatric MRI in Japan, outperforming dexmedetomidine and midazolam. Anesthesiologist administration and higher success rates drive this efficiency.
Area of Science:
- Pediatric Anesthesiology
- Health Economics
- Medical Imaging
Background:
- Pediatric magnetic resonance imaging (MRI) often requires sedation for successful completion.
- Evaluating the cost-effectiveness of different sedation regimens is crucial for optimizing healthcare resource allocation.
- Sedation practices in Japan for pediatric MRI vary, necessitating comparative analyses.
Purpose of the Study:
- To conduct a simulation-based cost-effectiveness analysis of various sedation regimens for pediatric MRI in Japan.
- To compare oral triclofos sodium, intravenous (IV) midazolam, IV dexmedetomidine, and IV propofol.
- To identify the most economically favorable sedation strategy for pediatric patients.
Main Methods:
- A decision tree model was developed for children aged 3 years (ASA-PS class I/II).
- Four sedation regimens were compared: triclofos sodium, midazolam, dexmedetomidine, and propofol.
- Cost-effectiveness was determined using incremental cost-effectiveness ratios (ICERs) and sensitivity analyses, including Monte Carlo simulations and cost-effectiveness acceptability curves (CEACs).
Main Results:
- Propofol and triclofos sodium formed the efficiency frontier, indicating superior value.
- Propofol demonstrated a favorable ICER compared to triclofos sodium ($3214.06 per averted sedation failure).
- Dexmedetomidine showed a negative ICER (-$9222.85), while midazolam and general anesthesia were less favorable based on CEACs.
Conclusions:
- Anesthesiologist-administered propofol sedation is more cost-effective than dexmedetomidine or midazolam administered by non-anesthesiologists for pediatric MRI.
- Higher success rates and lower reimbursement for anesthesiologist-administered sedation contribute to propofol's cost-effectiveness.
- Further real-world studies are recommended to validate these findings, with potential justification for increased reimbursement for anesthesiologist-administered sedation.
Purpose:
This simulation-based cost-effectiveness analysis evaluates various sedation regimens for pediatric magnetic resonance imaging (MRI) in Japan.
Methods:
A decision tree model was developed for children aged 3 years with ASA-PS class I/II to compare four sedation regimens: oral triclofos sodium, IV midazolam, IV dexmedetomidine, and IV propofol. The primary outcome was averted sedation failure (aSF). Cost-effectiveness was assessed using the incremental cost-effectiveness ratio (ICER). Deterministic and probabilistic sensitivity analyses, including Monte Carlo simulations and cost-effectiveness acceptability curves (CEACs), were performed. A 0% discount rate was applied. Our systematic literature search determined success rates for each sedation or general anesthesia regimen.
Results:
The cost-effectiveness plane demonstrated the efficiency frontier connecting triclofos sodium, propofol, and general anesthesia. Compared to oral triclofos sodium, propofol had an ICER of $3214.06 per additional aSF, which was more favorable than dexmedetomidine (ICER: -$9222.85). Sensitivity analysis showed that ICER values were most sensitive to the success rates of each sedation regimen, followed by the reimbursement rate for anesthesiologist-administered sedation. CEACs confirmed that triclofos sodium and propofol were the most favorable, while midazolam and general anesthesia were less favorable. The probability of cost-effectiveness for propofol varied from 0 to 51.6%, and for triclofos sodium, it ranged from 100 to 38.9%.
Conclusion:
Propofol sedation administered by anesthesiologists demonstrated superior cost-effectiveness compared to dexmedetomidine and midazolam sedation administered by non-anesthesiologists, primarily due to higher success rate and lower reimbursement rate for sedation procedures by anesthesiologists. Increasing reimbursement for anesthesiologist-administered sedation may be justifiable, though further real-world validation is needed.
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