PMID- 18211311
OWN - NLM
STAT- MEDLINE
DCOM- 20080529
LR  - 20191210
IS  - 1553-2712 (Electronic)
IS  - 1069-6563 (Linking)
VI  - 15
IP  - 1
DP  - 2008 Jan
TI  - A cost-effectiveness analysis of propofol versus midazolam for procedural 
      sedation in the emergency department.
PG  - 32-9
LID - 10.1111/j.1553-2712.2007.00023.x [doi]
AB  - 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.
FAU - Hohl, Corinne Michele
AU  - Hohl CM
AD  - Division of Emergency Medicine, Department of Surgery, University of British 
      Columbia, Vancouver Coastal Health Research Institute, Vancouver, British 
      Columbia, Canada. corinnehohl@yahoo.ca
FAU - Nosyk, Bohdan
AU  - Nosyk B
FAU - Sadatsafavi, Mohsen
AU  - Sadatsafavi M
FAU - Anis, Aslam Hayat
AU  - Anis AH
LA  - eng
PT  - Comparative Study
PT  - Evaluation Study
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - Acad Emerg Med
JT  - Academic emergency medicine : official journal of the Society for Academic 
      Emergency Medicine
JID - 9418450
RN  - 0 (Hypnotics and Sedatives)
RN  - R60L0SM5BC (Midazolam)
RN  - YI7VU623SF (Propofol)
SB  - IM
EIN - Acad Emerg Med. 2008 Mar;15(3):304
CIN - Acad Emerg Med. 2008 Jan;15(1):86-7. PMID: 18211319
MH  - Conscious Sedation/*economics/instrumentation
MH  - Cost-Benefit Analysis
MH  - Drug Costs
MH  - Emergency Service, Hospital/*economics
MH  - Humans
MH  - Hypnotics and Sedatives/*economics/therapeutic use
MH  - Midazolam/*economics/therapeutic use
MH  - North America
MH  - Propofol/*economics/therapeutic use
EDAT- 2008/01/24 09:00
MHDA- 2008/05/30 09:00
CRDT- 2008/01/24 09:00
PHST- 2008/01/24 09:00 [pubmed]
PHST- 2008/05/30 09:00 [medline]
PHST- 2008/01/24 09:00 [entrez]
AID - ACEM023 [pii]
AID - 10.1111/j.1553-2712.2007.00023.x [doi]
PST - ppublish
SO  - Acad Emerg Med. 2008 Jan;15(1):32-9. doi: 10.1111/j.1553-2712.2007.00023.x.