Dexmedetomidine versus standard care sedation with propofol or midazolam in intensive care: an economic evaluation

Abstract

IntroductionDexmedetomidine 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.MethodsThe 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.ResultsBased 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).ConclusionsFrom 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 registrationClinicalTrials.gov NCT00479661 (PRODEX), NCT00481312 (MIDEX).Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-015-0787-y) contains supplementary material, which is available to authorized users.

Dexmedetomidine: A Review of Its Use for Sedation in the Intensive Care Setting

“…A European cost-minimization analysis, based on the MIDEX and PRODEX trials, predicted that total ICU costs would be lower with dexmedetomidine than with midazolam or propofol [58]. Dexmedetomidine was associated with lower resource utilization compared with the pooled comparator population, mainly reflecting a significantly (p = 0.0003) shorter time to extubation, thus offsetting the higher acquisition cost of dexmedetomidine [58].…”

“…Dexmedetomidine was associated with lower resource utilization compared with the pooled comparator population, mainly reflecting a significantly (p = 0.0003) shorter time to extubation, thus offsetting the higher acquisition cost of dexmedetomidine [58].…”

Cost analysis of dexmedetomidine versus propofol during the implantation of a neurostimulator

“…4 This, despite the long required duration of administration compared to that in the implantation of a neurostimulator. 5 Third, although the costs of a procedure are important in themselves, the quality of the health care from the perspective of the patient, is increasingly seen as important. Considering this view and the results of our previous study, that is, the higher patient satisfaction and the allowance for better arousable sedation using dexmedetomidine compared to propofol, would justify a potential higher cost to a certain extent and was an additional reason to perform this analysis.…”

Dexmedetomidine for agitated delirium in intensive care unit intubated patients

“…Recently, Turunen et al (10) have highlighted a median sparing ICU total cost of 2,656 euros per patient in the MIDEX/PRODEX trials receiving dexmedetomidine. Carrasco et al (4) demonstrated a favorable cost-effectiveness profile of dexmedetomidine compared to haloperidol in the management of refractory delirium with a direct benefit due to the decrease of ICU stay and also an intangible or difficult-to-quantify benefit resulting by the potential decrease of orotracheal intubation risk.…”