Comparing the Costs Associated with Anxiolytic Agents for Reducing Distress in Children Undergoing Laceration Repair in the Emergency Department.

OBJECTIVES

The use of procedural medications for anxiolysis during laceration repair in children can mitigate distress, facilitate procedures, and avoid physical restraint. However, the optimal medication for use in the pediatric emergency department is unclear. This study compares hospital length of stay (LOS) and costs for 4 different procedural medications for pediatric laceration repair from the perspective of the Canadian health care system.

METHODS

We used an individual-level state-transition model to compare (i) intranasal midazolam (INM), (ii) inhaled nitrous oxide (NO), (iii) intranasal dexmedetomidine, and (iv) intravenous ketamine (IVK). Model inputs were informed by literature and expert consultations. LOS included time before, during, and after laceration repair, adjusting for adequacy of interventions and adverse events. Healthcare costs included personnel, equipment, and medication costs. We evaluated the drivers of model uncertainty using the TRansparent Uncertainty aSsessmenT (TRUST) tool and value of information analyses.

RESULTS

The estimated LOS for NO, INM, IVK, and intranasal dexmedetomidine were 78.34, 82.13, 103.37, and 114.55 minutes with the per-person estimated costs of $176.7, $122.79, $167.16, and $165.07, respectively. These results were limited by the low quality of available evidence for model inputs. The key parameters contributing to decision uncertainty were procedure time for NO and IVK, with an expected value of $5.31 and $0.44 per person, respectively.

CONCLUSION

INM had the lowest expected healthcare cost, whereas children receiving NO had the shortest expected LOS. Decision uncertainty was driven by the lack of relevant studies examining the length of procedure with NO and IVK use.