Economic benefits of remimazolam compared to midazolam and propofol for procedural sedation in colonoscopies and bronchoscopies

Abstract

Background

Sedation is common practice in endoscopic procedures to suppress a patient’s level of consciousness while maintaining the cardio-respiratory function. Midazolam and propofol are the sedatives most frequently used for procedural sedation at hospitals in Scandinavia. Remimazolam is a new ultra-short-acting benzodiazepine sedative and the present analysis aimed at estimating the economic benefits of introducing remimazolam for procedural sedation in colonoscopies and bronchoscopies in hospitals in Scandinavia.

Method

We developed a cost model applying a micro-costing approach that comprised the cost components that are affected by differences in the efficacy of remimazolam, midazolam, and propofol, and the model estimated the cost per successful colonoscopy and bronchoscopy when using remimazolam, midazolam or propofol as sedation. A micro-costing approach was applied, and the model consisted of six stages representing the journey for patients undergoing endoscopies and was informed primarily by data from clinical studies on remimazolam.

Results

We found a total cost of DKK 1200 per successful colonoscopy procedure when using remimazolam, a total cost of DKK 1320 when using midazolam, and a total cost of DKK 1255 when using propofol. Hence, the incremental saving per successful colonoscopy procedure of using remimazolam was estimated to be DKK 120 compared to midazolam and DKK 55 compared to propofol. The total cost per successful bronchoscopy procedure when using remimazolam was DKK 1353 and DKK 1724 for midazolam, resulting in an incremental saving per bronchoscopy of DKK 372 when using remimazolam. Performed sensitivity analyses identified the time in recovery as the largest contributor to uncertainty in the analyses of remimazolam compared to midazolam in colonoscopies and bronchoscopies. In the comparison of remimazolam and propofol in colonoscopies, procedure time was the largest contributor to uncertainty.

Conclusion

We found that procedural sedation with remimazolam was associated with economically meaningful savings compared to procedural sedation with midazolam and propofol in colonoscopies and to midazolam in bronchoscopies.

Keywords:

• Procedural sedation
• remimazolam
• midazolam
• propofol
• colonoscopies
• bronchoscopies
• cost analysis
• micro-costing

Transparency

Declaration of funding

Supported by PAION AG.

Declaration of financial/other relationships

Remimazolam is a product of PAION (funder). PAION provided support in the form of payments to EY Godkendt Revisionspartnerselskab. Authors L.K. and E.E. are employees at PAION. EY Godkendt Revisionspartnerselskab was a paid vendor to PAION and authors M.H.P., A.D., and E.M. are paid employees of EY Godkendt Revisionspartnerselskab. Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

M.H.P., A.D., and E.M. contributed to the study design, development of the economic model, and interpretation of the results. E.M. and M.H.P. drafted the manuscript. L.K. and E.E. contributed to the interpretation of the results, revision of the manuscript, and provided clinical expert knowledge. All authors have approved the final version of the manuscript to be published and agree to be accountable for all aspects of the work.

Acknowledgements

The authors would like to thank Frank Pott, Department of Anesthesiology and Intensive Care at Bispebjerg Hospital, Denmark, for providing insight into the clinical practice for procedural sedation and review of and feedback on the paper to the authors.