TY - JOUR
T1 - Dexmedetomidine versus standard care sedation with propofol or midazolam in intensive care: an economic evaluation
AU - Turunen, Heidi
AU - Jakob, Stephan
AU - Ruokonen, Esko T
AU - Kaukonen, Kirsi-Maija
AU - Sarapohja, Toni
AU - Apajasalo, Marjo
AU - Takala, Jukka
PY - 2015
Y1 - 2015
N2 - Introduction: Dexmedetomidine was shown in two European randomized double-blind double-dummy trials
(PRODEX and MIDEX) to be non-inferior to propofol and midazolam in maintaining target sedation levels in
mechanically ventilated intensive care unit (ICU) patients. Additionally, dexmedetomidine shortened the time to
extubation versus both standard sedatives, suggesting that it may reduce ICU resource needs and thus lower ICU
costs. Considering resource utilization data from these two trials, we performed a secondary, cost-minimization
analysis assessing the economics of dexmedetomidine versus standard care sedation.
Methods: The total ICU costs associated with each study sedative were calculated on the basis of total study
sedative consumption and the number of days patients remained intubated, required non-invasive ventilation, or
required ICU care without mechanical ventilation. The daily unit costs for these three consecutive ICU periods were
set to decline toward discharge, reflecting the observed reduction in mean daily Therapeutic Intervention Scoring
System (TISS) points between the periods. A number of additional sensitivity analyses were performed, including
one in which the total ICU costs were based on the cumulative sum of daily TISS points over the ICU period, and
two further scenarios, with declining direct variable daily costs only.
Results: Based on pooled data from both trials, sedation with dexmedetomidine resulted in lower total ICU costs
than using the standard sedatives, with a difference of ?2,656 in the median (interquartile range) total ICU costs?
?11,864 (?7,070 to ?23,457) versus ?14,520 (?7,871 to ?26,254)?and ?1,649 in the mean total ICU costs. The median
(mean) total ICU costs with dexmedetomidine compared with those of propofol or midazolam were ?1,292 (?747)
and ?3,573 (?2,536) lower, respectively. The result was robust, indicating lower costs with dexmedetomidine in all
sensitivity analyses, including those in which only direct variable ICU costs were considered. The likelihood of
dexmedetomidine resulting in lower total ICU costs compared with pooled standard care was 91.0 (72.4 versus
propofol and 98.0 versus midazolam).
Conclusions: From an economic point of view, dexmedetomidine appears to be a preferable option compared
with standard sedatives for providing light to moderate ICU sedation exceeding 24 hours. The savings potential
results primarily from shorter time to extubation.
Trial registration: ClinicalTrials.gov NCT00479661 (PRODEX), NCT00481312 (MIDEX)
AB - Introduction: Dexmedetomidine was shown in two European randomized double-blind double-dummy trials
(PRODEX and MIDEX) to be non-inferior to propofol and midazolam in maintaining target sedation levels in
mechanically ventilated intensive care unit (ICU) patients. Additionally, dexmedetomidine shortened the time to
extubation versus both standard sedatives, suggesting that it may reduce ICU resource needs and thus lower ICU
costs. Considering resource utilization data from these two trials, we performed a secondary, cost-minimization
analysis assessing the economics of dexmedetomidine versus standard care sedation.
Methods: The total ICU costs associated with each study sedative were calculated on the basis of total study
sedative consumption and the number of days patients remained intubated, required non-invasive ventilation, or
required ICU care without mechanical ventilation. The daily unit costs for these three consecutive ICU periods were
set to decline toward discharge, reflecting the observed reduction in mean daily Therapeutic Intervention Scoring
System (TISS) points between the periods. A number of additional sensitivity analyses were performed, including
one in which the total ICU costs were based on the cumulative sum of daily TISS points over the ICU period, and
two further scenarios, with declining direct variable daily costs only.
Results: Based on pooled data from both trials, sedation with dexmedetomidine resulted in lower total ICU costs
than using the standard sedatives, with a difference of ?2,656 in the median (interquartile range) total ICU costs?
?11,864 (?7,070 to ?23,457) versus ?14,520 (?7,871 to ?26,254)?and ?1,649 in the mean total ICU costs. The median
(mean) total ICU costs with dexmedetomidine compared with those of propofol or midazolam were ?1,292 (?747)
and ?3,573 (?2,536) lower, respectively. The result was robust, indicating lower costs with dexmedetomidine in all
sensitivity analyses, including those in which only direct variable ICU costs were considered. The likelihood of
dexmedetomidine resulting in lower total ICU costs compared with pooled standard care was 91.0 (72.4 versus
propofol and 98.0 versus midazolam).
Conclusions: From an economic point of view, dexmedetomidine appears to be a preferable option compared
with standard sedatives for providing light to moderate ICU sedation exceeding 24 hours. The savings potential
results primarily from shorter time to extubation.
Trial registration: ClinicalTrials.gov NCT00479661 (PRODEX), NCT00481312 (MIDEX)
UR - http://www.ccforum.com/content/pdf/s13054-015-0787-y.pdf
U2 - 10.1186/s13054-015-0787-y
DO - 10.1186/s13054-015-0787-y
M3 - Article
VL - 19
SP - 1
EP - 10
JO - Critical Care
JF - Critical Care
SN - 1364-8535
IS - 1 (Art. No:67)
ER -