Hohl Corinne Michèle, Nosyk Bohdan, Sadatsafavi Mohsen, Anis Aslam Hayat
Division of Emergency Medicine, Department of Surgery, University of British Columbia, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada.
Acad Emerg Med. 2008 Jan;15(1):32-9. doi: 10.1111/j.1553-2712.2007.00023.x.
To determine the incremental cost-effectiveness of using propofol versus midazolam for procedural sedation (PS) in adults in the emergency department (ED).
The authors conducted a cost-effectiveness analysis from the perspective of the health care provider. The primary outcome was the incremental cost (or savings) to achieve one additional successful sedation with propofol compared to midazolam. A decision model was developed in which the clinical effectiveness and cost of a PS strategy using either agent was estimated. The authors derived estimates of clinical effectiveness and risk of adverse events (AEs) from a systematic review. The cost of each clinical outcome was determined by incorporating the baseline cost of the ED visit, the cost of the drug, the cost of labor of physicians and nurses, the cost and probability of an AE, and the cost and probability of a PS failure. A standard meta-analytic technique was used to calculate the weighted mean difference in recovery times and obtain mean drug doses from patient-level data from a randomized controlled trial. Probabilistic sensitivity analyses were conducted to examine the uncertainty around the estimated incremental cost-effectiveness ratio using Monte Carlo simulation.
Choosing a sedation strategy with propofol resulted in average savings of $17.33 (95% confidence interval [CI] = $24.13 to $10.44) per sedation performed. This resulted in an incremental cost-effectiveness ratio of -$597.03 (95% credibility interval -$6,434.03 to $6,113.57) indicating savings of $597.03 per additional successful sedation performed with propofol. This result was driven by shorter recovery times and was robust to all sensitivity analyses performed.
These results indicate that using propofol for PS in the ED is a cost-saving strategy.
确定在急诊科（ED）对成人进行程序性镇静（PS）时，使用丙泊酚与咪达唑仑相比的增量成本效益。
作者从医疗服务提供者的角度进行了成本效益分析。主要结果是与咪达唑仑相比，使用丙泊酚实现一次额外成功镇静的增量成本（或节省）。开发了一个决策模型，其中估计了使用任何一种药物的PS策略的临床有效性和成本。作者通过系统评价得出临床有效性和不良事件（AE）风险的估计值。每个临床结果的成本通过纳入急诊就诊的基线成本、药物成本、医生和护士的劳动力成本、AE的成本和概率以及PS失败的成本和概率来确定。使用标准的荟萃分析技术计算恢复时间的加权平均差异，并从随机对照试验的患者水平数据中获得平均药物剂量。进行概率敏感性分析，以使用蒙特卡罗模拟检查估计的增量成本效益比周围的不确定性。
选择丙泊酚镇静策略，每次镇静平均节省17.33美元（95%置信区间[CI] = 24.13美元至10.44美元）。这导致增量成本效益比为-597.03美元（95%可信度区间为-6434.03美元至6113.57美元），表明使用丙泊酚进行每次额外成功镇静可节省597.03美元。这一结果是由较短的恢复时间驱动的，并且对所有进行的敏感性分析都具有稳健性。
这些结果表明，在急诊科使用丙泊酚进行PS是一种节省成本的策略。
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