小児MRI検査に対する鎮静レジメンの費用効果分析に基づく検査・処置時鎮静の再評価―令和8年度（2026年度）診療報酬改定を踏まえて―

Reconsidering Procedural Sedation Outside the Operating Room Based on Cost-Effectiveness Analyses of Sedation Regimens for Pediatric Magnetic Resonance Imaging：Implications of the 2026 Revision of the Japanese Reimbursement System

はじめに

　小児の磁気共鳴画像（magnetic resonance imaging：MRI）検査では，一定時間の静止が求められるため，年齢や発達段階によっては鎮静または全身麻酔が必要となる^1）2）。検査・処置時鎮静は，検査・処置の成立，安全性，検査・処置の質，さらに再検査回避や患者・家族負担の軽減を支える医療介入である^1）～4）。しかしわが国では，手術室外で行われる検査・処置時鎮静の診療報酬上の評価は，その臨床的重要性に比して十分とは言いがたかった^5）。近年，小児MRI鎮静レジメンの費用効果分析により，麻酔科医の関与を検査完遂率や医療資源配分の観点から定量的にとらえる視点が提示された^3）4）。さらに令和8年度（2026年度）診療報酬改定では，鎮静，深鎮静，全身麻酔の評価体系が，麻酔の深度，気道確保の有無，管理体制を含む形で再整理された^5）6）。本論文では，これらの知見と制度改定を踏まえ，検査・処置時鎮静の価値と今後の体制整備のあり方を再考する。

　Procedural sedation outside the operating rooms in Japan needs a broader evaluation. Findings from cost-effectiveness analyses of sedation regimens for pediatric magnetic resonance imaging（MRI）, together with the 2026 revision of the Japanese reimbursement system under the national fee schedule, support the need for this broader evaluation. In pediatric MRI, sedation is not only a supportive technique. It can affect safety, the completion of the examination, image quality, the burden on patients and families, and the use of medical resources. Findings from our cost-effectiveness analyses suggest that the involvement of anesthesiologists, especially in cases involving propofol-based sedation, may be justified not only by clinical performance but also by efficiency. The 2026 reimbursement revision also introduced a new category for deep sedation and placed greater emphasis on patient assessment, monitoring, and institutional readiness. These changes support a broader understanding of the value of sedation. Procedural sedation should be evaluated not only based on the direct costs or major adverse events but also by its contribution to successful care, quality, the patient and family members’ experience, and efficient system operation. A multidimensional approach may better reflect the value of procedural sedation in current practice.