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Cost-effectiveness analysis of clinic-based chloral hydrate sedation versus general anaesthesia for paediatric ophthalmological procedures. | LitMetric

Cost-effectiveness analysis of clinic-based chloral hydrate sedation versus general anaesthesia for paediatric ophthalmological procedures.

Br J Ophthalmol

Department of Paediatric Ophthalmology, University of Toronto and Staff Ophthalmologist, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, Canada.

Published: November 2015

AI Article Synopsis

  • * It found that examinations under sedation (EUS) cost significantly less, averaging $406 per patient, compared to the $1135 for examinations under anesthesia (EUA), but EUA resulted in more successful procedures.
  • * Overall, the research indicated that while EUS is more cost-effective, EUA yields a higher number of successful procedures, highlighting the trade-off between cost and effectiveness in outpatient settings.

Article Abstract

Background/aims: 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.

Download full-text PDF

Source
http://dx.doi.org/10.1136/bjophthalmol-2015-306604DOI Listing

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