OBJECTIVES: Remimazolam is an ultra-short acting benzodiazepine and due to its pharmacokinetic-pharmacodynamic profile was approved by EMA in March 2021 for procedural sedation (PSA).

Based on clinical study data, remimazolam offers the potential to anesthesiologists to allocate responsibilities to a broader pool of Health Care Professionals trained in sedation whilst ensuring adequate continuous monitoring and support. Due to its rapid onset of action, favorable safety profile, and short recovery time, the complete procedure process is potentially shorter versus current standard of care (SoC) with potentially less side-effects. This analysis aims to estimate the financial impact of remimazolam in PSA 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. CNS7056-006, CNS-7056-008 and CNS-7056-015), 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 in Belgium. A cost minimization approach allowed to estimate the financial impact of remimazolam versus midazolam in Belgian clinical practice.

RESULTS: Up to 51 € per PSA procedure or 10% of the budget needed can be saved versus midazolam from NIHDI perspective while the hospitals can save 45 € per procedure 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 sedation by reallocating scarce resources. While offering an environmentally valuable alternative to SoC, the potential for shorter procedures can result in optimized availability of the operating theatres and post-sedation care units. This can result in improved access to healthcare, generating savings for both the government and hospitals.