Dexmedetomidine is an alpha-2 receptor agonist used in continuous infusion for the sedation of critically ill patients in intensive care unit who are intubated and mechanically ventilated. Compared to midazolam in the sedation of intensive care unit patients, dexmedetomidine showed a decrease in time spent on ventilator, fewer episodes of delirium and reduced incidence of tachycardia and hypertension. The aim of this study was to assess the economic impact, in a Canadian context, of dexmedetomidine for sedation in intensive unit care compare with midazolam, a GABA agonist.
This economic evaluation was performed using a cost-consequences analysis, according the perspective of Canadian Health Care system. The time horizon chosen is an intensive care unit stay with a maximum length of 30 days. Clinical data were obtained from a prospective randomized, double-blinded trial by Riker and al. comparing dexmedetomidine and midazolam. Costs considered in this evaluation were those of the medications, of the mechanical ventilation, of the delirium episodes, and those associated with adverse events requiring an intervention. All costs were adjusted to 2010 and were reported in Canadian dollars.
The average cost of medication was higher with dexmedetomidine ($1,930) than with midazolam ($180), but the average cost associated with mechanical ventilation and with the management of delirium were lower with dexmedetomidine ($2,939 and $3,630 respectively) than with midazolam ($4,448 and $5,149). Overall cost per patient with dexmedetomidine ($8,525) was lower than with midazolam ($9,817). Deterministic sensitivity analysis confirmed the robustness of this difference.
The results of this cost-consequences analysis indicated that the use of dexmedetomidine is a favorable strategy in terms of clinical consequences and economic impact compare to midazolam. Compared to midazolam, dexmedetomidine is a less expensive strategy associated with a lower occurrence of delirium and a shorter duration of mechanical ventilation.
© 2011 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc.