Cost-effectiveness of transversus abdominis plane block versus caudal block for pediatric lower abdominal surgery under general anesthesia: a simulation-based study

Abstract Introduction The economic implications of transversus abdominis plane block (TAPB) versus caudal block (CB) for pediatric lower abdominal surgery remain unclear. Methods We developed a decision tree from the Japanese public healthcare payer perspective, comparing general anesthesia plus standard-case TAPB with general anesthesia plus CB for a representative 3-year-old child. Outcomes were expected reimbursed expenditure and quality-adjusted life years (QALYs) over 7 postoperative days. Uncertainty was examined using deterministic and probabilistic sensitivity analyses, threshold analysis, and scenario analyses. Results Expected reimbursed expenditure was JPY 751.8 for TAPB and JPY 2089.6 for CB. The modeled QALY gain with TAPB was small (0.000042). In probabilistic sensitivity analysis, TAPB had lower reimbursed expenditure and higher QALYs in 99.77% of simulations. The cost-parity and cost-effectiveness reimbursement thresholds were 178.8 and 199.8 points, respectively. Conclusion Standard-case TAPB showed favorable reimbursement-based cost-effectiveness compared with CB under the assumptions of this model.