A cost-minimization analysis of dexmedetomidine compared with midazolam for long-term sedation in the intensive care unit.
OBJECTIVE
To compare the intensive care unit costs and determine factors influencing these costs in mechanically ventilated patients randomized to dexmedetomidine or midazolam by continuous infusion.


METHODS
Cost minimization analysis of a double-blind, multicenter clinical trial randomizing patients 2:1 to receive dexmedetomidine or midazolam from the institutional perspective.


METHODS
Sixty-eight intensive care units in the United States, Australia, New Zealand, Brazil, and Argentina.


METHODS
A total of 366 intubated intensive care unit patients anticipated to require sedation for >24 hrs.


RESULTS
Intensive care unit resource use was compared within the two treatment arms, using the U.S. representative costs for these resources. The analyses characterized patient costs from start of study drug until intensive care unit discharge including costs associated with the intensive care unit stay, costs during mechanical ventilation, study drug acquisition cost, and costs of treating adverse drug reactions probably or possibly related to study drugs. Blinded to treatment group, costs were calculated using Medicare reimbursement schedules, average IMS drug costs, expert opinion, and peer-reviewed literature. Censored lengths of intensive care unit stay and mechanical ventilation were imputed, using a nonparametric adjustment algorithm. Crude and multivariate median regressions were performed to relate intensive care unit cost and treatment. Including drug acquisition cost, sedation with dexmedetomidine was associated with a median total intensive care unit cost savings of $9679 (confidence interval, $2314-$17,045) compared with midazolam. The primary cost drivers were reduced costs of intensive care unit stay (median savings, $6584, 95% confidence interval, $727-$12,440) and reduced costs of mechanical ventilation (median savings, $2958, 95% confidence interval, $698-$5219).


CONCLUSIONS
Continuous sedation with dexmedetomidine results in significantly lower total intensive care unit costs compared with midazolam infusion for intensive care unit sedation, primarily due to decreased intensive care unit stay costs and reduced mechanical ventilation costs.
Dasta
Joseph F
JF
Ohio State University, USA. jdasta@mail.utexas.edu
Kane-Gill
Sandra L
SL
Pencina
Michael
M
Shehabi
Yahya
Y
Bokesch
Paula M
PM
Wisemandle
Wayne
W
Riker
Richard R
RR
D017046:Cost Savings / Q000191:economics; D003362:Cost-Benefit Analysis; D003422:Critical Care / Q000191:economics* / Q000379:methods; D020927:Dexmedetomidine / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use; D007362:Intensive Care Units / Q000191:economics; D008134:Long-Term Care / Q000191:economics / Q000379:methods; D008297:Male; D008874:Midazolam / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use; D012121:Respiration, Artificial / Q000191:economics / Q000379:methods; D016896:Treatment Outcome; D014481:United States
D006993:Hypnotics and Sedatives; D020927:Dexmedetomidine; D008874:Midazolam