A Cost-Minimization Analysis Comparing Dexmedetomidine with Midazolam and Propofol for Sedation in Mechanically Ventilated Intensive Care Unit Patients
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Objectives: Dexmedetomidine was shown in two randomized clinical trials (MIDEX and PRO- DEX studies) to be non-inferior to midazolam and propofol in maintaining light to moderate seda- tion levels in mechanically ventilated intensive care unit (ICU) patients. In addition, compared with midazolam and propofol, dexmedetomidine shortens the time to extubation and the time spent in ICU. Based on the resource utilization data from these studies, we perform a cost-minimization analy- sis to assess the economic impact of dexmedetomidine versus midazolam and propofol. Methods: This analysis estimates the total healthcare costs in an ICU from a healthcare system perspective. The healthcare costs comprise the costs of medication, administration, test/diagnostic examina- tions, and the treatment of adverse events. Results: Based on MIDEX and PRODEX studies, seda- tion with dexmedetomidine resulted in lower total costs than when using midazolam or propofol. The total cost of dexmedetomidine was estimated at 2874367 KRW in the MIDEX study and 2280374 KRW in the PRODEX study. The cost difference between midazolam and propofol treat- ments were 369179 KRW and 311088 KRW, respectively shown in the two studies. An additional sensitivity analysis confirmed that dexmedetomidine has a lower cost than those of the compara- tors. Conclusion: From an economic point of view, dexmedetomidine is a cheaper treatment option than either midazolam or propofol when providing light to moderate sedation levels in mechanically ventilated ICU patients.
Abstract
Objectives: Dexmedetomidine was shown in two randomized clinical trials (MIDEX and PRO- DEX studies) to be non-inferior to midazolam and propofol in maintaining light to moderate seda- tion levels in mechanically ventilated intensive care unit (ICU) patients. In addition, compared with midazolam and propofol, dexmedetomidine shortens the time to extubation and the time spent in ICU. Based on the resource utilization data from these studies, we perform a cost-minimization analy- sis to assess the economic impact of dexmedetomidine versus midazolam and propofol. Methods: This analysis estimates the total healthcare costs in an ICU from a healthcare system perspective. The healthcare costs comprise the costs of medication, administration, test/diagnostic examina- tions, and the treatment of adverse events. Results: Based on MIDEX and PRODEX studies, seda- tion with dexmedetomidine resulted in lower total costs than when using midazolam or propofol. The total cost of dexmedetomidine was estimated at 2874367 KRW in the MIDEX study and 2280374 KRW in the PRODEX study. The cost difference between midazolam and propofol treat- ments were 369179 KRW and 311088 KRW, respectively shown in the two studies. An additional sensitivity analysis confirmed that dexmedetomidine has a lower cost than those of the compara- tors. Conclusion: From an economic point of view, dexmedetomidine is a cheaper treatment option than either midazolam or propofol when providing light to moderate sedation levels in mechanically ventilated ICU patients.
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