Cost-effectiveness analysis of anaesthesia regimens for paediatric strabismus surgery based on multicentre retrospective cohort data from Japan

BJA open Pub Date : 2025-05-07 DOI:10.1016/j.bjao.2025.100404

Soichiro Obara , Taiki Kojima , Yusuke Yamauchi , Takashi Fujiwara , Aya Sueda , Riku Takahashi

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Abstract

Background

Postoperative vomiting (POV) after paediatric strabismus surgery poses both clinical and economic challenges. This study evaluates the cost-effectiveness of different anaesthesia regimens, focusing on the addition of ondansetron (OND), in preventing POV.

Methods

A cost-effectiveness analysis was conducted from the perspective of a Japanese public healthcare payer using retrospective cohort data of children (aged 3–15 years) undergoing strabismus surgery at three institutions (February 2016–November 2023). The primary outcome measure was cost per averted POV (aPOV) within 24 hours post-surgery. Incremental cost-effectiveness ratios were calculated, and sensitivity analyses accounted for uncertainties.

Results

A total of 2772 patients were included. Total intravenous anaesthesia (TIVA) regimens were compared, as OND was used only in TIVA regimens. The aPOV rate for TIVA with sub-Tenon block and dexamethasone (DEX) was 91.0%, whereas TIVA with sub-Tenon block, DEX, and OND had an aPOV rate of 96.3%. The incremental cost of adding OND was €21.2, resulting in an incremental cost-effectiveness ratio of €400.6 per aPOV. A sensitivity analysis showed OND cost was the most influential factor. The cost-effectiveness acceptability frontier showed the probability of cost-effectiveness for TIVA+DEX ranged from 0% to 97.4% for thresholds of €0–€200 per aPOV, whereas TIVA+DEX+OND raged from 0% to 9.3%, and TIVA only ranged from 100% to 0%.

Conclusions

TIVA with DEX alone is the most cost-effective regimen for preventing POV in paediatric strabismus surgery in the current Japanese public healthcare system. The addition of OND in TIVA regimens may not be justified from the viewpoint of cost-effectiveness.

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基于日本多中心回顾性队列数据的小儿斜视手术麻醉方案的成本-效果分析

背景：小儿斜视手术后呕吐（POV）带来了临床和经济上的挑战。本研究评估了不同麻醉方案的成本效益，重点是添加昂丹司琼（OND）预防POV。方法以日本公共医疗支付方为研究对象，对2016年2月- 2023年11月在三家机构接受斜视手术的3-15岁儿童进行回顾性队列数据分析。主要结局指标是术后24小时内每个避免的POV （aPOV）的成本。计算了增量成本-效果比，并对不确定性进行了敏感性分析。结果共纳入2772例患者。全静脉麻醉（TIVA）方案进行比较，因为只有在TIVA方案中使用了OND。亚榫阻断+地塞米松（DEX）的TIVA aPOV率为91.0%，而亚榫阻断+ DEX + OND的TIVA aPOV率为96.3%。增加OND的增量成本为21.2欧元，每aPOV的增量成本效益比为400.6欧元。敏感性分析显示，OND成本是影响最大的因素。成本-效果可接受边界显示，对于每个aPOV 0 - 200欧元的阈值，TIVA+DEX的成本-效果概率在0% - 97.4%之间，而TIVA+DEX+OND的成本-效果概率在0% - 9.3%之间，TIVA的成本-效果可接受边界仅在100% - 0%之间。结论在目前的日本公共医疗体系中，单纯使用stiva联合DEX是预防小儿斜视手术中POV最具成本效益的方案。从成本效益的角度来看，在TIVA方案中增加OND可能是不合理的。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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