title: Cost-effectiveness analysis of clinic-based chloral hydrate sedation versus general anaesthesia for paediatric ophthalmological procedures.
abstract: OBJECTIVE
  The inability of some children to tolerate detailed eye examinations often necessitates general anaesthesia (GA). The objective was to assess the incremental cost effectiveness of paediatric eye examinations carried out in an outpatient sedation unit compared with GA.
  
  
  METHODS
  An episode of care cost-effectiveness analysis was conducted from a societal perspective. Model inputs were based on a retrospective cross-over cohort of Canadian children aged <7 years who had both an examination under sedation (EUS) and examination under anaesthesia (EUA) within an 8-month period. Costs ($CAN), adverse events and number of successful procedures were modelled in a decision analysis with one-way and probabilistic sensitivity analysis.
  
  
  RESULTS
  The mean cost per patient was $406 (95% CI $401 to $411) for EUS and $1135 (95% CI $1125 to $1145) for EUA. The mean number of successful procedures per patient was 1.39 (95% CI 1.34 to 1.42) for EUS and 2.06 (95% CI 2.02 to 2.11) for EUA. EUA was $729 more costly on average than EUS (95% CI $719 to $738) but resulted in an additional 0.68 successful procedures per child. The result was robust to varying the cost assumptions.
  
  
  CONCLUSIONS
  Cross-over designs offer a powerful way to assess costs and effectiveness of two interventions because patients serve as their own control. This study demonstrated significant savings when ophthalmological exams were carried out in a hospital outpatient clinic, although with slightly fewer procedures completed.
authors.affiliation: Program of Child Health Evaluative Sciences, The Hospital for Sick Children Peter Gilgan Centre for Research and Learning, Toronto, Ontario, Canada.
authors.forename: Heather F
authors.initials: HF
authors.lastname: Burnett
authors.affiliation: Queen's Medical Centre, Nottingham, UK.
authors.forename: Rosemary
authors.initials: R
authors.lastname: Lambley
authors.affiliation: Department of Paediatric Ophthalmology, Southampton General Hospital, Southampton, UK.
authors.forename: Stephanie K
authors.initials: SK
authors.lastname: West
authors.affiliation: Program of Child Health Evaluative Sciences, The Hospital for Sick Children Peter Gilgan Centre for Research and Learning, Toronto, Ontario, Canada.
authors.forename: Wendy J
authors.initials: WJ
authors.lastname: Ungar
authors.affiliation: Department of Paediatric Ophthalmology, University of Toronto and Staff Ophthalmologist, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, Canada.
authors.forename: Kamiar
authors.initials: K
authors.lastname: Mireskandari
mesh_terms: D000768:Anesthesia, General / Q000191:economics*; D002648:Child; D002675:Child, Preschool; D002697:Chloral Hydrate / Q000008:administration & dosage / Q000191:economics*; D016292:Procedural Sedation / Q000191:economics*; D003362:Cost-Benefit Analysis; D018592:Cross-Over Studies; D003941:Diagnostic Techniques, Ophthalmological / Q000191:economics*; D016527:Drug Costs; D017050:Episode of Care; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage / Q000191:economics*; D007223:Infant; D008297:Male; D010045:Outpatients; D010808:Physical Examination; D011788:Quality of Life; D012189:Retrospective Studies
chemical_list: D006993:Hypnotics and Sedatives; D002697:Chloral Hydrate
keywords: Child health (paediatrics); Treatment other