Teikyo University Graduate School of Public Health, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-8605, Japan.
Department of Anesthesia, Saitama Children's Medical Center, 1-2 Shin-toshin, Chuo-ku, Saitama-city, Saitama, 330-8777, Japan.
J Anesth. 2022 Jun;36(3):359-366. doi: 10.1007/s00540-022-03051-w. Epub 2022 Mar 3.
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.
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.
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.
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.
在日本，由于报销问题，麻醉医生主导的镇静服务尚未得到很好的建立。在这项研究中，我们根据日本医疗费用表，比较了非麻醉医生镇静与麻醉医生镇静或全身麻醉的成本效益。
我们进行了一项单中心观察性研究，纳入了在 12 个月期间因磁共振成像（MRI）需要镇静或全身麻醉的患者。在决策树中对每位患者的成本和成像失败率进行建模，并进行敏感性分析。成本从医疗保健部门的角度进行估计。
共分析了 1546 名患者。非麻醉医生镇静的失败率为 17.5%（264 例/1506 例），而所有麻醉医生镇静和全身麻醉均成功。以成功镇静为结果的成本效益分析显示，麻醉医生镇静的每位患者平均成本为 84.2 美元，其次是非麻醉医生静脉镇静的 74.2-92.7 美元、非麻醉医生口服或直肠镇静的 112.1-458.3 美元，以及麻醉医生全身麻醉的 605.4 美元。单因素敏感性分析表明，只要口服或直肠途径的镇静失败率分别超过 11.3%或静脉途径超过 3.6%，非麻醉医生的镇静每位患者成本将始终高于麻醉医生的镇静。
在日本医疗费用表中，对于接受 MRI 的儿童，麻醉医生主导的镇静比非麻醉医生的口服或直肠镇静更具成本效益。
