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

 

Research

Heidi Turunen1*, Stephan M Jakob2, Esko Ruokonen3, Kirsi-Maija Kaukonen45, Toni Sarapohja1, Marjo Apajasalo1 and Jukka Takala2

  • *
    Corresponding author: Heidi Turunen heidi.turunen@orionpharma.com

Author Affiliations

1 Orion Corporation Orion Pharma, Espoo, FI-02100, Finland

2 Department of Intensive Care Medicine, Bern University Hospital and University of Bern, Bern, CH-3010, Switzerland

3 Department of Intensive Care Medicine, Kuopio University Hospital, Kuopio, FI-70210, Finland

4 Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, 3004, Victoria, Australia

5 Intensive Care Units, Helsinki University Central Hospital, Helsinki, 00029 HUS, Finland

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Critical Care 2015, 19:67 
doi:10.1186/s13054-015-0787-y

Published: 19 February 2015

Abstract (provisional)

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 it may reduce ICU resource needs and thus lower ICU costs. Based
on 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 based
on 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 towards
discharge, reflecting the observed reduction in mean daily TISS points between the
periods. A number of additional sensitivity analyses were performed, including one
where 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 – 23,457)
versus €14,520 (7,871 – 26,254)), and €1,649 in the mean total ICU costs. Compared
to propofol or midazolam, the median (mean) total ICU costs with dexmedetomidine 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 where
only direct variable ICU costs were considered. The likelihood of dexmedetomidine
resulting in lower total ICU costs compared to pooled standard care was 91.0% (72.4%
versus propofol, 98.0% versus midazolam). Conclusions From an economic point of view,
dexmedetomidine appears to be a preferable option compared to 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).