A Cost-effectiveness Analysis of Propofol versus Midazolam for Procedural Sedation in the Emergency Department |
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Authors: | Corinne Michè le Hohl,MD,CCFP,FRCP,,Bohdan Nosyk,MA,,Mohsen Sadatsafavi,MD,MSHc,,Aslam Hayat Anis,PhD |
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Affiliation: | Division of Emergency Medicine, Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver Coastal Health Research Institute (CMH);the Center for Health Evaluation and Outcome Sciences, Providence Health Care Institute (BN, AHA);the Health Economics Program, Center for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute (MS);and the Department of Health Care and Epidemiology, Faculty of Medicine (AHA), University of British Columbia, Vancouver, British Columbia, Canada. |
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Abstract: | Objectives: To determine the incremental cost-effectiveness of using propofol versus midazolam for procedural sedation (PS) in adults in the emergency department (ED). Methods: The authors conducted a cost-effectiveness analysis from the perspective of the health care provider. The primary outcome was the incremental cost (or savings) to achieve one additional successful sedation with propofol compared to midazolam. A decision model was developed in which the clinical effectiveness and cost of a PS strategy using either agent was estimated. The authors derived estimates of clinical effectiveness and risk of adverse events (AEs) from a systematic review. The cost of each clinical outcome was determined by incorporating the baseline cost of the ED visit, the cost of the drug, the cost of labor of physicians and nurses, the cost and probability of an AE, and the cost and probability of a PS failure. A standard meta-analytic technique was used to calculate the weighted mean difference in recovery times and obtain mean drug doses from patient-level data from a randomized controlled trial. Probabilistic sensitivity analyses were conducted to examine the uncertainty around the estimated incremental cost-effectiveness ratio using Monte Carlo simulation. Results: Choosing a sedation strategy with propofol resulted in average savings of $17.33 (95% confidence interval [CI] = $24.13 to $10.44) per sedation performed. This resulted in an incremental cost-effectiveness ratio of –$597.03 (95% credibility interval –$6,434.03 to $6,113.57) indicating savings of $597.03 per additional successful sedation performed with propofol. This result was driven by shorter recovery times and was robust to all sensitivity analyses performed. Conclusions: These results indicate that using propofol for PS in the ED is a cost-saving strategy. |
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Keywords: | propofol midazolam procedural sedation conscious sedation resource utilization cost-effectiveness analysis |
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