Department of Emergency Medicine, University of Iowa College of Medicine, 200 Hawkins Drive, 1008 RCP, Iowa City, IA, 52242, USA.
Division of Critical Care, Department of Anesthesia, University of Iowa Carver College of Medicine, 200 Hawkins Drive, 1008 RCP, Iowa City, IA, 52242, USA.
Intern Emerg Med. 2018 Jan;13(1):75-85. doi: 10.1007/s11739-016-1587-3. Epub 2016 Dec 28.
End-tidal CO has been advocated to improve safety of emergency department (ED) procedural sedation by decreasing hypoxia and catastrophic outcomes. This study aimed to estimate the cost-effectiveness of routine use of continuous waveform quantitative end-tidal CO monitoring for ED procedural sedation in prevention of catastrophic events. Markov modeling was used to perform cost-effectiveness analysis to estimate societal costs per prevented catastrophic event (death or hypoxic brain injury) during routine ED procedural sedation. Estimates for efficacy of capnography and safety of sedation were derived from the literature. This model was then applied to all procedural sedations performed in US EDs with assumptions selected to maximize efficacy and minimize cost of implementation. Assuming that capnography decreases the catastrophic adverse event rate by 40.7% (proportional to efficacy in preventing hypoxia), routine use of capnography would decrease the 5-year estimated catastrophic event rate in all US EDs from 15.5 events to 9.2 events (difference 6.3 prevented events per 5 years). Over a 5-year period, implementing routine end-tidal CO monitoring would cost an estimated $2,830,326 per prevented catastrophic event, which translates into $114,007 per quality-adjusted life-year. Sensitivity analyses suggest that reasonable assumptions continue to estimate high costs of prevented catastrophic events. Continuous waveform quantitative end-tidal CO monitoring is a very costly strategy to prevent catastrophic complications of procedural sedation when applied routinely in ED procedural sedations.
呼气末二氧化碳监测被提倡用于提高急诊科（ED）程序镇静的安全性，以降低缺氧和灾难性结局的风险。本研究旨在评估在预防灾难性事件中，常规使用连续波定量呼气末二氧化碳监测对 ED 程序镇静的成本效益。采用马尔可夫模型进行成本效益分析，以估计在常规 ED 程序镇静中，每预防一次灾难性事件（死亡或缺氧性脑损伤）的社会成本。呼气末二氧化碳监测的有效性和镇静安全性的估计值来自文献。然后将该模型应用于美国所有 ED 进行的所有程序镇静，并选择假设以最大程度地提高疗效和降低实施成本。假设呼气末二氧化碳监测将灾难性不良事件发生率降低 40.7%（与预防缺氧的疗效成比例），则常规使用呼气末二氧化碳监测将使所有美国 ED 中 5 年内预计的灾难性事件发生率从 15.5 例降低至 9.2 例（每 5 年预防 6.3 例事件）。在 5 年内，实施常规呼气末二氧化碳监测的估计成本为每预防一次灾难性事件 283.0326 美元，这相当于每质量调整生命年 114,007 美元。敏感性分析表明，合理的假设仍然估计预防灾难性事件的成本很高。连续波定量呼气末二氧化碳监测是一种非常昂贵的策略，用于预防 ED 程序镇静中灾难性并发症，当常规应用于 ED 程序镇静时。
