title: Dexmedetomidine versus standard care sedation with propofol or midazolam in intensive care: an economic evaluation.
abstract: BACKGROUND
  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 that it may reduce ICU resource needs and thus lower ICU costs. Considering 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 on the basis of 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 toward discharge, reflecting the observed reduction in mean daily Therapeutic Intervention Scoring System (TISS) points between the periods. A number of additional sensitivity analyses were performed, including one in which 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 to €23,457) versus €14,520 (€7,871 to €26,254)-and €1,649 in the mean total ICU costs. The median (mean) total ICU costs with dexmedetomidine compared with those of propofol or midazolam 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 in which only direct variable ICU costs were considered. The likelihood of dexmedetomidine resulting in lower total ICU costs compared with pooled standard care was 91.0% (72.4% versus propofol and 98.0% versus midazolam).
  
  
  CONCLUSIONS
  From an economic point of view, dexmedetomidine appears to be a preferable option compared with standard sedatives for providing light to moderate ICU sedation exceeding 24 hours. The savings potential results primarily from shorter time to extubation.
  
  
  BACKGROUND
  ClinicalTrials.gov NCT00479661 (PRODEX), NCT00481312 (MIDEX).
authors.affiliation: Orion Corporation Orion Pharma, Orionintie 1, FI-02100, Espoo, Finland. heidi.turunen@orionpharma.com.
authors.forename: Heidi
authors.initials: H
authors.lastname: Turunen
authors.affiliation: Department of Intensive Care Medicine, Bern University Hospital and University of Bern, Freiburgstrasse, CH-3010, Bern, Switzerland. stephan.jakob@insel.ch.
authors.forename: Stephan M
authors.initials: SM
authors.lastname: Jakob
authors.affiliation: Department of Intensive Care Medicine, Kuopio University Hospital, Puijonlaaksontie 2, FI-70210, Kuopio, Finland. esko.ruokonen@kuh.fi.
authors.forename: Esko
authors.initials: E
authors.lastname: Ruokonen
authors.affiliation: Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, 99 Commercial Road, 3004, Melbourne, Victoria, Australia. maija.kaukonen@hus.fi.|Intensive Care Units, Helsinki University Central Hospital, Haartmaninkatu 2, 00029 HUS, Helsinki, Finland. maija.kaukonen@hus.fi.
authors.forename: Kirsi-Maija
authors.initials: KM
authors.lastname: Kaukonen
authors.affiliation: Orion Corporation Orion Pharma, Orionintie 1, FI-02100, Espoo, Finland. toni.sarapohja@orionpharma.com.
authors.forename: Toni
authors.initials: T
authors.lastname: Sarapohja
authors.affiliation: Orion Corporation Orion Pharma, Orionintie 1, FI-02100, Espoo, Finland. marjo.apajasalo@orionpharma.com.
authors.forename: Marjo
authors.initials: M
authors.lastname: Apajasalo
authors.affiliation: Department of Intensive Care Medicine, Bern University Hospital and University of Bern, Freiburgstrasse, CH-3010, Bern, Switzerland. jukka.takala@insel.ch.
authors.forename: Jukka
authors.initials: J
authors.lastname: Takala
mesh_terms: D016292:Procedural Sedation / Q000191:economics* / Q000379:methods; D020927:Dexmedetomidine / Q000191:economics / Q000627:therapeutic use*; D006760:Hospitalization / Q000191:economics*; D006801:Humans; D006993:Hypnotics and Sedatives / Q000191:economics / Q000627:therapeutic use*; D007362:Intensive Care Units / Q000191:economics; D008874:Midazolam / Q000191:economics / Q000627:therapeutic use*; D015742:Propofol / Q000191:economics / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic; D012121:Respiration, Artificial
chemical_list: D006993:Hypnotics and Sedatives; D020927:Dexmedetomidine; D008874:Midazolam; D015742:Propofol