Saunders Rhodri, Davis Jason A, Kranke Peter, Weissbrod Rachel, Whitaker David K, Lightdale Jenifer R
Coreva Scientific GmbH & Co KG, Freiburg, Germany.
Department of Anaesthesia and Critical Care, University of Würzburg, Würzburg, Germany.
Ther Clin Risk Manag. 2018 Feb 28;14:393-401. doi: 10.2147/TCRM.S154720. eCollection 2018.
Studies have reported on the incidence of sedation-related adverse events (AEs), but little is known about their impact on health care costs and resource use.
Health care providers and payers in five countries were recruited for an online survey by independent administrators to ensure that investigators and respondents were blinded to each other. Surveys were conducted in the local language and began with a "screener" to ensure that respondents had relevant expertise and experience. Responses were analyzed using Excel and R, with the Dixon's statistic used to identify and remove outliers. Global and country-specific average treatment patterns were calculated via bootstrapping; costs were mean values. The sum product of costs and intervention probability gave a cost per AE.
Responses were received from 101 providers and 26 payers, the majority having >5 years of experience. At a minimum, the respondents performed a total of 3,430 procedural sedations per month. All AEs detailed occurred in clinical practice in the last year and were reported to cause procedural delays and cancellations in some patients. Standard procedural sedation costs ranged from €74 (Germany) to $2,300 (US). Respondents estimated that AEs would increase costs by between 16% (Italy) and 179% (US). Hypotension was reported as the most commonly observed AE with an associated global mean cost (interquartile range) of $43 ($27-$68). Other frequent AEs, including mild hypotension, bradycardia, tachycardia, mild oxygen desaturation, hypertension, and brief apnea, were estimated to increase health care spending on procedural sedation by $2.2 billion annually in the US.
All sedation-related AEs can increase health care costs and result in substantial delays or cancellations of subsequent procedures. The prevention of even minor AEs during procedural sedation may be crucial to ensuring its value as a health care service.
已有研究报道了与镇静相关的不良事件（AE）的发生率，但对于这些事件对医疗保健成本和资源使用的影响却知之甚少。
五个国家的医疗保健提供者和支付方由独立管理人员招募参加在线调查，以确保调查人员和受访者相互不知情。调查以当地语言进行，并以一个“筛选器”开始，以确保受访者具备相关专业知识和经验。使用Excel和R对回复进行分析，采用狄克逊统计量来识别和去除异常值。通过自展法计算全球和特定国家的平均治疗模式；成本为平均值。成本与干预概率的乘积得出每个不良事件的成本。
收到了101名提供者和26名支付方的回复，大多数人有超过5年的经验。受访者每月至少总共进行3430例程序性镇静。所有详细的不良事件均发生在过去一年的临床实践中，并据报道在一些患者中导致了程序延误和取消。标准程序性镇静成本从74欧元（德国）到2300美元（美国）不等。受访者估计，不良事件将使成本增加16%（意大利）至179%（美国）。据报告，低血压是最常观察到的不良事件，相关的全球平均成本（四分位间距）为43美元（27 - 68美元）。其他常见的不良事件，包括轻度低血压、心动过缓、心动过速、轻度氧饱和度降低、高血压和短暂呼吸暂停，估计每年会使美国程序性镇静的医疗保健支出增加22亿美元。
所有与镇静相关的不良事件都会增加医疗保健成本，并导致后续程序的大量延误或取消。在程序性镇静期间预防即使是轻微的不良事件对于确保其作为一种医疗保健服务的价值可能至关重要。
