OBJECTIVES: Remimazolam is an ultra-short acting benzodiazepine and due to its pharmacokinetic- pharmacodynamic profile was approved by EMA in March 2023 for general anesthesia (GA).

Based on the clinical study data, remimazolam adds to anesthesiologist armamentarium in general anesthesia whilst ensuring adequate continuous monitoring and support. Besides its rapid onset of action and short recovery time, remimazolam offers a favorable hemodynamic stability and safety profile versus current standard of care (SoC) with especially less hypotension. Given the excellent sedative properties and improved safety profile of remimazolam compared to other anesthetics, such as propofol, a shift from GA to PSA could occur. This analysis aims to estimate the financial impact versus SoC from different perspectives.

METHODS: A dynamic simulation model was developed to simulate the impact for the payer (NIHDI) or hospitals. Clinical data were collected from several phase 3 trials (incl. ONO-2754-05 and CNS-7056-022), while units and costs were sourced from literature and extended input from Belgian clinical experts. Drug costs were excluded as remimazolam is not yet reimbursed. A cost minimization approach allowed to estimate the financial impact of remimazolam versus propofol and sevoflurane in Belgian clinical practice.

RESULTS: Per GA procedure (induction/maintenance), remimazolam has the potential to save 183 € or 21% budget versus propofol from NIHDI perspective. But, when switching to hospital perspective, savings can be realized versus both propofol (790 € per procedure or 24%) and sevoflurane (468 € per procedure or 16%), while allowing to relocate scarce resources towards structural improved healthcare management.

CONCLUSIONS: Remimazolam is the first novel anesthetic in decades with the potential to optimize the organization of clinical practice in GA by reallocating scarce resources. While offering an environmentally valuable alternative to SoC, remimazolam can result in optimized access to healthcare, generating savings for both the government and hospitals.