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

Figures & data

Figure 1. Structure of the health economic model.

Figure 2. Tornado diagrams from DSA, change in incremental cost of remimazolam compared to midazolam and propofol in colonoscopies and midazolam in bronchoscopies.

Table 1. Time-use (in minutes) and presence of HCPs during colonoscopies and bronchoscopies by procedural sedation.

	Colonoscopy			Bronchoscopy
	Remimazolam^14^a,b	Midazolam^14^a,b	Propofol^14^a,b	Remimazolam^a,b	Midazolam^a,b
Study	004	004	006/RF-5	008	008
Stage 0: Preparation
Treatment room	2.64	4.85	2.64	4.1	15.5
Waiting room	0	0	0	0	0
Personnel
Nurse	2	2	1	2	2
Nurse anesthetist			1
Surgeon/endoscopist	1	1		1	1
Anesthesiologist			1
Stage 1A: Procedure
Treatment room	10	10	10	10	10
Waiting room	0	0	0	0	0
Personnel
Nurse	2	2	1	2	2
Nurse anesthetist			1
Surgeon/endoscopist	1	1	1	1	1
Anesthesiologist			1
Stage 2: Recovery
Treatment room	6	13	6	6	12
Waiting room	0	0	0	0	0
Personnel
Nurse	2	2	1	2	2
Nurse anesthetist			1
Stage 3: Discharge
Treatment room	0	0	0	0	0
Waiting room	38	35	38	54	54
Personnel
Nurse	1	1	1	1	1
Stage 1B: Rescue sedative medication
Treatment room	0	0	0	0	0
Waiting room	38	0	38	0	0
Stage 1C: Cancelled procedure
Treatment room	6	13	6	6	12
Waiting room	38	35	38	54	54
Personnel
Nurse	2	2	1	2	2
Nurse anesthetist			1
Porter	1	1	1	1	1

Note: Due to the lack of appropriate data that reflects clinical practice for propofol in Scandinavia in colonoscopies, we assumed that the time estimates for propofol were equal to the time estimates for remimazolam.

^aInput from clinical experts.

^bData on file.

Table 2. Procedure outcomes and use of rescue sedative medication.

	Uncomplicated (%)	Requiring rescue sedative			Unsuccessful procedure (%)
		Share (%)	Dose
			Propofol (mg)	Midazolam (mg)
Colonoscopy procedure^14^a
Remimazolam	97.50	2.50	50	–	2.50
Midazolam	75	25	50	–	0.00
Propofol	100	0	50	–	0
Bronchoscopy procedure^12
Remimazolam	84	16	–	7.85	3
Midazolam	44	57	–	4.58	7

^aData on file.

Table 3. Unit costs.

Cost category	Unit cost, DKK
Hourly cost of healthcare personnel^19^a
Nurse	554.00
- During recovery	184.67
Nurse anesthetist	609.40
Surgeon/endoscopist	1316.00
Anesthesiologist	1447.60
Porter	460.00
Hourly cost of physical facilities^20
Treatment room	28.44
Waiting room	11.38
Utensil package^21^a
Total cost	56.50
Alcohol swab	0.31
Venflon	3.30
Band-aid	1.03
Gloves	0.22
Sterile water	14.00
Syringes	0.21
Needles	0.08
Saline bag (NaCl)	32.00
Drop set	4.40
Drug costs^b
Remimazolam
Price per vial	156.20
Price per mg	7.81
Midazolam
Price per vial	3.75
Price per mg	0.75
Propofol
Price per vial	9.50
Price per mg	0.05
Fentanyl
Price per vial	18.00
Price per mg	36.00

^aInput from clinical experts.

^bDrug costs obtained from www.medicinpriser.dk (October 2021).

Table 4. Results: procedural sedation in colonoscopies.

	Remimazolam	Midazolam	Propofol	Difference
				Remimazolam vs. Midazolam	Remimazolam vs. Propofol
Drug costs (DKK)	93	9	8	84	85
Hospital costs (DKK)	832	1024	978	−192	−147
Patient time and transport costs (DKK)	276	288	269	−12	7
Total costs (DKK)	1200	1320	1255	−120	−55

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