Inhaled Methoxyflurane in Australian Emergency Departments-A Cost-Minimisation Analysis

Around 60% of emergency department (ED) patients present with pain. With growing ED-demand, there is need for analgesic options that reduce resource use and cost. We estimate the potential cost-savings from broader use of inhaled methoxyflurane in Australian EDs compared with standard-of-care (SOC) analgesics or procedural sedation. The analysis focused on non-admitted patient presentations requiring analgesia or procedural sedation to treat dislocations, burns, fractures and other injuries.

We conducted a cost-minimisation analysis to assess differences in resource use and costs between methoxyflurane, and SOC. Model inputs were informed by a literature review, consultation with ED-clinicians and Australian Institute of Health and Welfare data, adjusted to 2024/25 population estimates. Costs are reported in 2024/25 Australian dollars, per use case and on aggregate across Australian EDs. Intravenous ketamine, identified by clinicians as the most common comparator, was presented by indication. Sensitivity analyses were undertaken to assess robustness.

Methoxyflurane use could have been associated with lower per-patient costs than SOC, driven primarily by reduced ED length of stay and staff time. Estimated cost per use case ranged from $62-$283 compared with intranasal fentanyl and $339-$560 compared with intravenous ketamine. At a national level, this equated to potential annual ED-operational efficiency gains of $9.5-$42.9 million and $34.6-$85.0 million, respectively. Methoxyflurane used for shoulder dislocations contributed an estimated $1.9-$4.8 million when compared to intravenous ketamine.

Broader use of methoxyflurane for the management of pain and minor procedures in Australian EDs could deliver meaningful operational efficiency gains.