Clinical and economic burden of procedural sedation-related adverse events and their outcomes: analysis from five countries
Received 21 October 2017
Accepted for publication 30 December 2017
Published 28 February 2018 Volume 2018:14 Pages 393—401
Checked for plagiarism Yes
Review by Single-blind
Peer reviewer comments 2
Editor who approved publication: Professor Garry Walsh
Rhodri Saunders,1 Jason A Davis,1 Peter Kranke,2 Rachel Weissbrod,3 David K Whitaker,4 Jenifer R Lightdale5
1Coreva Scientific GmbH & Co KG, Freiburg, Germany; 2Department of Anaesthesia and Critical Care, University of Würzburg, Würzburg, Germany; 3Medical Affairs, Medtronic, Jerusalem, Israel; 4Department of Anaesthesia, Manchester Royal Infirmary, Manchester, UK; 5Pediatric Gastroenterology, Hepatology and Nutrition, University of Massachusetts, Worcester, MA, USA
Background: Studies have reported on the incidence of sedation-related adverse events (AEs), but little is known about their impact on health care costs and resource use.
Methods: Health care providers and payers in five countries were recruited for an online survey by independent administrators to ensure that investigators and respondents were blinded to each other. Surveys were conducted in the local language and began with a “screener” to ensure that respondents had relevant expertise and experience. Responses were analyzed using Excel and R, with the Dixon’s Q statistic used to identify and remove outliers. Global and country-specific average treatment patterns were calculated via bootstrapping; costs were mean values. The sum product of costs and intervention probability gave a cost per AE.
Results: Responses were received from 101 providers and 26 payers, the majority having >5 years of experience. At a minimum, the respondents performed a total of 3,430 procedural sedations per month. All AEs detailed occurred in clinical practice in the last year and were reported to cause procedural delays and cancellations in some patients. Standard procedural sedation costs ranged from €74 (Germany) to $2,300 (US). Respondents estimated that AEs would increase costs by between 16% (Italy) and 179% (US). Hypotension was reported as the most commonly observed AE with an associated global mean cost (interquartile range) of $43 ($27–$68). Other frequent AEs, including mild hypotension, bradycardia, tachycardia, mild oxygen desaturation, hypertension, and brief apnea, were estimated to increase health care spending on procedural sedation by $2.2 billion annually in the US.
Conclusion: All sedation-related AEs can increase health care costs and result in substantial delays or cancellations of subsequent procedures. The prevention of even minor AEs during procedural sedation may be crucial to ensuring its value as a health care service.
Keywords: costs, complications, moderate sedation, questionnaire, survey, health care payers
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