title: Cost effectiveness of a benzodiazepine vs a nonbenzodiazepine-based sedation regimen for mechanically ventilated, critically ill adults.
abstract: OBJECTIVE
  Nonbenzodiazepine sedation (eg, dexmedetomidine or propofol) may be more cost effective than benzodiazepine (BZ) sedation despite its higher acquisition cost.
  
  
  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): $35380 (71.0%) vs $45394 (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.
authors.affiliation: School of Pharmacy, Northeastern University, Boston, MA.
authors.forename: Justin J
authors.initials: JJ
authors.lastname: Bioc
authors.affiliation: School of Pharmacy, Northeastern University, Boston, MA.
authors.forename: Chelsea
authors.initials: C
authors.lastname: Magee
authors.affiliation: School of Pharmacy, Northeastern University, Boston, MA.
authors.forename: James
authors.initials: J
authors.lastname: Cucchi
authors.affiliation: Maine Medical Center, Portland, ME.
authors.forename: Gilles L
authors.initials: GL
authors.lastname: Fraser
authors.affiliation: College of Pharmacy, University of Texas, Austin, TX.
authors.forename: Joseph F
authors.initials: JF
authors.lastname: Dasta
authors.affiliation: School of Pharmacy, Northeastern University, Boston, MA; Department of Health Sciences, Northeastern University, Boston, MA.
authors.forename: Roger A
authors.initials: RA
authors.lastname: Edwards
authors.affiliation: School of Pharmacy, Northeastern University, Boston, MA. Electronic address: j.devlin@neu.edu.
authors.forename: John W
authors.initials: JW
authors.lastname: Devlin
mesh_terms: D000328:Adult; D001569:Benzodiazepines / Q000008:administration & dosage / Q000191:economics*; D002985:Clinical Protocols; D003362:Cost-Benefit Analysis; D016638:Critical Illness; D020927:Dexmedetomidine / Q000008:administration & dosage / Q000191:economics*; D016527:Drug Costs; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage / Q000191:economics*; D007362:Intensive Care Units / Q000191:economics; D008390:Markov Chains; D015742:Propofol / Q000008:administration & dosage / Q000191:economics*; D012121:Respiration, Artificial / Q000191:economics* / Q000379:methods; D012680:Sensitivity and Specificity
chemical_list: D006993:Hypnotics and Sedatives; D001569:Benzodiazepines; D020927:Dexmedetomidine; D015742:Propofol
keywords: Cost effectiveness; Dexmedetomidine; Intensive care unit; Lorazepam; Midazolam; Propofol