Cost effectiveness of a benzodiazepine vs a nonbenzodiazepine-based sedation regimen for mechanically ventilated, critically ill adults.
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): $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.
['Bioc|Justin J|JJ|', 'Magee|Chelsea|C|', 'Cucchi|James|J|', 'Fraser|Gilles L|GL|', 'Dasta|Joseph F|JF|', 'Edwards|Roger A|RA|', 'Devlin|John W|JW|']
D000328:Adult D001569:Benzodiazepines D002985:Clinical Protocols D003362:Cost-Benefit Analysis D016638:Critical Illness D020927:Dexmedetomidine D016527:Drug Costs D006801:Humans D006993:Hypnotics and Sedatives D007362:Intensive Care Units D008390:Markov Chains D015742:Propofol D012121:Respiration, Artificial D012680:Sensitivity and Specificity
Cost effectiveness Dexmedetomidine Propofol Intensive care unit Lorazepam Midazolam