A cost-effectiveness analysis of propofol versus midazolam for procedural sedation in the emergency department.
OBJECTIVE
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.
Hohl
Corinne Michèle
CM
Division of Emergency Medicine, Department of Surgery, University of British Columbia, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada. corinnehohl@yahoo.ca
Nosyk
Bohdan
B
Sadatsafavi
Mohsen
M
Anis
Aslam Hayat
AH
D016292:Procedural Sedation / Q000191:economics* / Q000295:instrumentation; D003362:Cost-Benefit Analysis; D016527:Drug Costs; D004636:Emergency Service, Hospital / Q000191:economics*; D006801:Humans; D006993:Hypnotics and Sedatives / Q000191:economics* / Q000627:therapeutic use; D008874:Midazolam / Q000191:economics* / Q000627:therapeutic use; D009656:North America; D015742:Propofol / Q000191:economics* / Q000627:therapeutic use
D006993:Hypnotics and Sedatives; D008874:Midazolam; D015742:Propofol