Managing postoperative vomiting (POV) in children undergoing strabismus surgery remains a significant concern for healthcare providers and families alike. A recent study conducted across three Japanese institutions provides new insights into the most economically viable anesthesia strategies to mitigate this issue.
Study Overview and Methodology
Researchers analyzed data from 2,772 pediatric patients, aged 3 to 15, who underwent strabismus surgery between February 2016 and November 2023. The study focused on comparing various total intravenous anaesthesia (TIVA) regimens, particularly examining the role of ondansetron (OND) when combined with sub-Tenon block and dexamethasone (DEX). Cost-effectiveness was assessed from the perspective of Japan’s public healthcare system, with the primary metric being the cost per averted POV within the first 24 hours post-operation.
Key Findings and Economic Implications
The analysis revealed that the addition of OND to the TIVA with sub-Tenon block and DEX regimen increased the aPOV rate from 91.0% to 96.3%. However, this improvement came at an incremental cost of ¥21.2 per aPOV, resulting in an incremental cost-effectiveness ratio of ¥400.6 per aPOV. Sensitivity analyses indicated that the cost of OND was the most significant factor influencing overall cost-effectiveness.
- The most cost-effective regimen without OND achieved high aPOV rates at a lower overall cost.
- Adding OND provided marginal benefits that may not justify the additional expense within the current healthcare framework.
- Healthcare policymakers should consider these findings when developing guidelines for pediatric anesthesia practices.
Optimal management of POV in pediatric patients not only enhances patient comfort and recovery but also reduces the economic burden on healthcare systems. This study underscores the importance of evaluating both clinical outcomes and cost implications when selecting anesthesia protocols.
Implementing TIVA with DEX alone emerges as the most financially sustainable approach for preventing postoperative vomiting in children undergoing strabismus surgery in Japan. While the addition of OND offers slight improvements in aPOV rates, the associated costs may outweigh the benefits, suggesting that current public healthcare resources could be better allocated elsewhere to maximize patient outcomes and economic efficiency.
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