Cost-effectiveness analysis of sedation and general anesthesia regimens for children undergoing magnetic resonance imaging in Japan.

PURPOSE

The anesthesiologist-directed sedation service has not been well established in Japan partly due to reimbursement issue. In this study, we compared the cost-effectiveness of sedation by non-anesthesiologists with that of sedation or general anesthesia by anesthesiologists under the Japanese medical fee schedule.

METHODS

We conducted a single-center observational study with patients who required sedation or general anesthesia for magnetic resonance imaging (MRI) during a 12-month period. Costs per patient and failure rates of imaging were modeled in a decision analysis tree with sensitivity analysis. Costs were estimated from the health-care sector perspective.

RESULTS

A total of 1546 patients were analyzed. The failure rate of sedation by non-anesthesiologists was 17.5% (264 out of 1506), whereas all the sedation and general anesthesia by anesthesiologists were successful. The cost-effectiveness analysis with setting successful sedation as outcomes showed that the mean cost per patient was 84.2 USD for sedation by anesthesiologists, followed by 74.2-92.7 USD for intravenous sedation by non-anesthesiologists, 112.1-458.3 USD for oral or rectal sedation by non-anesthesiologists, and 605.4 USD for general anesthesia by anesthesiologists. The one-way sensitivity analysis demonstrated that the cost per patient of sedation by a non-anesthesiologist would remain higher than that of sedation by an anesthesiologist, provided that the failure rate is over 11.3% for sedation via oral or rectal route, or over 3.6% for intravenous route, respectively.

CONCLUSIONS

Anesthesia-directed sedation would be more cost-effective than oral or rectal sedation by non-anesthesiologists for children undergoing MRI in the Japanese medical fee schedule.