Cost effectiveness of a benzodiazepine vs a nonbenzodiazepine-based sedation regimen for mechanically ventilated, critically ill adults
| Autor: | Roger A. Edwards, James Cucchi, Chelsea E. Magee, John W. Devlin, Justin J. Bioc, Gilles L. Fraser, Joseph F. Dasta |
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| Rok vydání: | 2014 |
| Předmět: |
Adult
Cost effectiveness Cost-Benefit Analysis Critical Illness Sedation medicine.medical_treatment Critical Care and Intensive Care Medicine Sensitivity and Specificity Drug Costs law.invention Benzodiazepines Clinical Protocols law medicine Humans Hypnotics and Sedatives Dexmedetomidine Propofol health care economics and organizations Mechanical ventilation business.industry Lorazepam Respiration Artificial Intensive care unit Markov Chains Intensive Care Units Anesthesia Midazolam medicine.symptom business medicine.drug |
| Zdroj: | Journal of Critical Care. 29:753-757 |
| ISSN: | 0883-9441 |
| Popis: | Purpose Nonbenzodiazepine sedation (eg, dexmedetomidine or propofol) may be more cost effective than benzodiazepine (BZ) sedation despite its higher acquisition cost. Materials and methods A cost effectiveness (CE) analysis of noncardiac surgery, critically ill adults requiring at least 1 day of mechanical ventilation (MV) and administered either BZ or non-BZ sedation, that cycled health states and costs daily using a Markov model accounting for daily MV use until intensive care unit (ICU) discharge, was conducted from a third-party perspective. Transition probabilities were obtained from a published meta-analysis, and costs were estimated from best evidence. Sensitivity analyses were run for all extubation and discharge probabilities, for different cost estimates and for the specific non-BZ administered. Results When non-BZ rather than BZ sedation was used, the incremental cost-effectiveness ratio to avert 1 ICU day while MV or while either MV or non-MV was $3406 and $3136, respectively. The base-case analysis revealed that non-BZ sedation (vs BZ sedation) resulted in higher drug costs ($1327 vs $65) but lower total ICU costs (percent accounted for MV need): $35 380 (71.0%) vs $45 394 (70.6%). Sensitivity analysis revealed that BZ sedation would only be less costly if the daily rate of extubation was at least 16%, and the daily rate of ICU discharge without MV was at least 77%. The incremental CE ratio to avert 1 ICU day while MV or non-MV was similar between the dexmedetomidine and propofol non-BZ options. Conclusions Among MV adults, non-BZ sedation has a more favorable CE ratio than BZ sedation over most cost estimates. |
| Databáze: | OpenAIRE |
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