Pharmacoeconomic Modeling of Lorazepam, Midazolam, and Propofol for Continuous Sedation in Critically Ill Patients

MacLaren, Robert; Sullivan, Patrick W.

doi:10.1592/phco.2005.25.10.1319

Cited by 23 publications

(18 citation statements)

References 66 publications

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“…22,23 All sedatives were converted to midazolam equivalents (midazolam 5 mg/hr = lorazepam 3 mg/hr = propofol 200 mg/hr = dexmedetomidine 74.1 lg/hr), and all opioids were converted to fentanyl equivalents. [24][25][26] The average hourly sedative infusion rate was calculated for each 6-hour period based on midazolam equivalents. Daily sedation interruption, if completed, was documented.…”

Section: Data Collectionmentioning

confidence: 99%

Effect of Extracorporeal Membrane Oxygenation Use on Sedative Requirements in Patients with Severe Acute Respiratory Distress Syndrome

et al. 2016

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Section: Data Collectionmentioning

confidence: 99%

Effect of Extracorporeal Membrane Oxygenation Use on Sedative Requirements in Patients with Severe Acute Respiratory Distress Syndrome

et al. 2016

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“…[5][6][7] The results of studies comparing the commonly used sedatives, lorazepam, midazolam, and propofol, are conflicting with respect to time to awakening, ventilation duration, and intensive care unit (ICU) length of stay after discontinuing sedation. [8][9][10] In general, propofol is associated with rapid awakening and subsequent tracheal extubation, but its cost and adverse-event profile prohibit common use, especially for long-term therapy. In contrast, the benzodiazepines are inexpensive but are associated with excessive sedation, slow awakening, and delayed tracheal extubation.…”

mentioning

confidence: 99%

Adjunctive Dexmedetomidine Therapy in the Intensive Care Unit: A Retrospective Assessment of Impact on Sedative and Analgesic Requirements, Levels of Sedation and Analgesia, and Ventilatory and Hemodynamic Parameters

MacLaren¹,

Forrest²,

Kiser³

2007

Pharmacotherapy

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Adjunctive dexmedetomidine reduces sedative requirements but does not alter analgesic requirements. However, dexmedetomidine was associated with enhanced agitation, severe pain, and hemodynamic compromise. Transitioning to dexmedetomidine from other sedatives and analgesics may not provide optimal sedation and analgesia. Future studies are needed to evaluate dexmedetomidine as a bridge to extubation.

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“…Additional limitations of past work include incorporation of medication costs instead of overall hospitalization costs, data collection within different countries during times when comparative exchange rates are difficult to now appreciate, consideration of only short-term sedation, lack of sensitivity analysis use to examine the impact of data input uncertainty, and inclusion of propofol costs based on its more expensive branded formulation. (32,(34)(35)(36)(37) Because of the ubiquity of sedative use in the ICU setting, we believe that our results underscore the importance of determining whether clinically important differences exist among commonly used sedatives with respect to mechanical ventilation-free days and length of stay. For example, assuming equivalence in ventilator-free days and length of stay, a hospital treating 1,000 ventilated patients annually could theoretically save over $300,000 by using midazolam instead of propofol.…”

Section: Discussionmentioning

confidence: 79%

Economic evaluation of propofol and lorazepam for critically ill patients undergoing mechanical ventilation*

Cox

Reed

Govert

et al. 2008

Critical Care Medicine

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Objective-The economic implications of sedative choice in the management of patients receiving mechanical ventilation are unclear because of differences in costs and clinical outcomes associated with specific sedatives. Therefore, we aimed to determine the cost-effectiveness of the most commonly used sedatives prescribed for mechanically ventilated critically ill patients.Design, Setting, and Patients-Adopting the perspective of a hospital, we developed a probabilistic decision model to determine if continuous propofol or intermittent lorazepam was associated with greater value when combined with daily awakenings. We also evaluated the comparative value of continuous midazolam in secondary analyses. We assumed that patients were managed in a medical intensive care unit and expected to require ventilation for at least 48 hours. Author contributions:Christopher Cox: Final approval, concept and design, acquisition of data, analysis and interpretation of data, drafting of the manuscript, critical revision of the manuscript, statistical analysis, obtaining funding, administrative support, and supervision. Shelby Reed: Final approval, concept and design, analysis and interpretation of data, critical revision of the manuscript, and administrative, technical, or material support. Joseph Govert: Final approval, concept and design, analysis and interpretation of data, critical revision of the manuscript, administrative support, and supervision. Jo Ellen Rodgers: Final approval, conception and design, acquisition of data, analysis and interpretation of data, critical revision of the manuscript, obtaining funding, and supervision. Stacy Campbell-Bright: Final approval, acquisition of data, analysis and interpretation of data, critical revision of the manuscript, and administrative support. John Kress: Final approval, concept and design, acquisition of data, drafting of the manuscript, obtaining funding, administrative support, critical revision of the manuscript, and supervision. Shannon Carson: Final approval, concept and design, acquisition of data, analysis and interpretation of data, obtaining funding, critical revision of the manuscript, and supervision. NIH Public AccessAuthor Manuscript Crit Care Med. Author manuscript; available in PMC 2009 October 19. NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author ManuscriptModel inputs were derived from primary analysis of randomized controlled trial data, medical literature, Medicare reimbursement rates, pharmacy databases, and institutional data.Main Results-We measured cost-effectiveness as costs per mechanical ventilator-free day within the first 28 days after intubation. Our base-case probabilistic analysis demonstrated that propofol dominated lorazepam in 91% of simulations and, on average, was both $6,378 less costly per patient and associated with over three additional mechanical ventilator-free days. The model did not reveal clinically meaningful differences between propofol and midazolam on costs or measures of effectiveness.Conclusion-Propofol ...

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Pharmacoeconomic Modeling of Lorazepam, Midazolam, and Propofol for Continuous Sedation in Critically Ill Patients

Abstract: Propofol, midazolam, and lorazepam had the lowest expected costs for short-, intermediate-, and long-term sedation, respectively. Many factors aside from drug costs influenced the cost of sedation.

Cited by 23 publications

References 66 publications

Effect of Extracorporeal Membrane Oxygenation Use on Sedative Requirements in Patients with Severe Acute Respiratory Distress Syndrome

Effect of Extracorporeal Membrane Oxygenation Use on Sedative Requirements in Patients with Severe Acute Respiratory Distress Syndrome

Adjunctive Dexmedetomidine Therapy in the Intensive Care Unit: A Retrospective Assessment of Impact on Sedative and Analgesic Requirements, Levels of Sedation and Analgesia, and Ventilatory and Hemodynamic Parameters

Economic evaluation of propofol and lorazepam for critically ill patients undergoing mechanical ventilation*

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