Obara Soichiro, Nakata Yoshinori
Teikyo University Graduate School of Public Health, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-8605, Japan.
J Anesth. 2025 Jul 11. doi: 10.1007/s00540-025-03540-8.
This simulation-based cost-effectiveness analysis evaluates various sedation regimens for pediatric magnetic resonance imaging (MRI) in Japan.
A decision tree model was developed for children aged 3 years with ASA-PS class I/II to compare four sedation regimens: oral triclofos sodium, IV midazolam, IV dexmedetomidine, and IV propofol. The primary outcome was averted sedation failure (aSF). Cost-effectiveness was assessed using the incremental cost-effectiveness ratio (ICER). Deterministic and probabilistic sensitivity analyses, including Monte Carlo simulations and cost-effectiveness acceptability curves (CEACs), were performed. A 0% discount rate was applied. Our systematic literature search determined success rates for each sedation or general anesthesia regimen.
The cost-effectiveness plane demonstrated the efficiency frontier connecting triclofos sodium, propofol, and general anesthesia. Compared to oral triclofos sodium, propofol had an ICER of $3214.06 per additional aSF, which was more favorable than dexmedetomidine (ICER: -$9222.85). Sensitivity analysis showed that ICER values were most sensitive to the success rates of each sedation regimen, followed by the reimbursement rate for anesthesiologist-administered sedation. CEACs confirmed that triclofos sodium and propofol were the most favorable, while midazolam and general anesthesia were less favorable. The probability of cost-effectiveness for propofol varied from 0 to 51.6%, and for triclofos sodium, it ranged from 100 to 38.9%.
Propofol sedation administered by anesthesiologists demonstrated superior cost-effectiveness compared to dexmedetomidine and midazolam sedation administered by non-anesthesiologists, primarily due to higher success rate and lower reimbursement rate for sedation procedures by anesthesiologists. Increasing reimbursement for anesthesiologist-administered sedation may be justifiable, though further real-world validation is needed.
本基于模拟的成本效益分析评估了日本小儿磁共振成像（MRI）的各种镇静方案。
针对年龄3岁、ASA-PS分级为I/II级的儿童建立决策树模型，以比较四种镇静方案：口服三氯福司钠、静脉注射咪达唑仑、静脉注射右美托咪定和静脉注射丙泊酚。主要结局为避免镇静失败（aSF）。使用增量成本效益比（ICER）评估成本效益。进行了确定性和概率敏感性分析，包括蒙特卡罗模拟和成本效益可接受性曲线（CEAC）。采用0%的贴现率。我们的系统文献检索确定了每种镇静或全身麻醉方案的成功率。
成本效益平面显示了连接三氯福司钠、丙泊酚和全身麻醉的效率前沿。与口服三氯福司钠相比，丙泊酚每增加一个aSF的ICER为3214.06美元，比右美托咪定更具优势（ICER：-9222.85美元）。敏感性分析表明，ICER值对每种镇静方案的成功率最敏感，其次是麻醉医生实施镇静的报销率。CEAC证实，三氯福司钠和丙泊酚最具优势，而咪达唑仑和全身麻醉则较不具优势。丙泊酚成本效益的概率从0到51.6%不等，三氯福司钠的概率范围为100到38.9%。
麻醉医生实施的丙泊酚镇静与非麻醉医生实施的右美托咪定和咪达唑仑镇静相比，具有更高的成本效益，主要是因为麻醉医生实施镇静的成功率更高且报销率更低。增加麻醉医生实施镇静的报销可能是合理的，不过还需要进一步的实际验证。
