medigraphic.com
ISSN 2448-8909 (Print)

2013, Number 4

<< Back Next >>

Med Crit 2013; 27 (4)

Dextmedetomidine versus midazolam for continuous sedation in the Intensive Care Unit: A cost analysis in Mexico

Carlos RFJ, Ortiz IR

Language: Spanish
References: 29
Page: 200-207
PDF size: 202.78 Kb.


Text Extraction

Introduction: Sedation is an integral part of the medical attention in the Intensive Care Unit (ICU).
Objective: The aim of this study is to evaluate the costs of schemes for sedation based on dexmedetomidine or midazolam and to identify the magnitude of the potential savings when dexmedetomidine is used instead of midazolam for continuous sedation in the Intensive Care Unit.
Methods: A cost-minimization analysis was performed under the perspective of the Mexican public health care system. The evaluated categories included the acquisition of the agents for sedation and the Intensive Care Unit stay. The information regarding doses, treatment duration and length of Intensive Care Unit stay was obtained from a clinical trial (SEDCOM) which directly compared the interventions of interest. The unit costs were gathered from the Mexican Institute of Social Security and are expressed in Mexican pesos (2013 year).
Results: For a 70 kg patient, the sedation based on dexmedetomidine is less costly than that based on midazolam: $194,299 versus $239,220. The difference ($44,921) is equivalent to a reduction of 19% in the cost of the scheme with midazolam. The results are robust to variation of the parameters.
Conclusion: Despite higher acquisition costs, dexmedetomidine offers substantial net savings for the continuous sedation in the Intensive Care Unit.


REFERENCES

  1. Laing R, Waning B, Gray A, Ford N, ‘t Hoen E. 25 years of the WHO essential medicines lists: progress and challenges. Lancet. 2003;361(9370):1723-1729.

  2. Kahn JM. Understanding economic outcomes in critical care. Curr Opin Crit Care. 2006;12(5):399-404.

  3. Zilberberg MD. Understanding cost-effectiveness in the ICU. Semin Respir Crit Care Med. 2010;31(1):13-18.

  4. Ostermann ME, Keenan SP, Seiferling RA, Sibbald WJ. Sedation in the intensive care unit: a systematic review. JAMA. 2000;283(11):1451-1459.

  5. Kress JP, Hall JB. Sedation in the mechanically ventilated patient. Crit Care Med. 2006;34(10):2541-2546.

  6. Stevanovic PD, Petrova G, Miljkovic B, et al. Low fresh gas flow balanced anesthesia versus target controlled intravenous infusion anesthesia in laparoscopic cholecystectomy: a cost-minimization analysis. Clin Ther. 2008;30(9):1714-1725.

  7. Sessler CN, Varney K. Patient-focused sedation and analgesia in the ICU. Chest. 2008;133(2):552-565.

  8. Robinson BR, Mueller EW, Henson K, Branson RD, Barsoum S, Tsuei BJ. An analgesia-delirium-sedation protocol for critically ill trauma patients reduces ventilator days and hospital length of stay. J Trauma. 2008;65(3):517-526.

  9. Dasta JF, McLaughlin TP, Mody SH, Piech CT. Daily cost of an intensive care unit day: the contribution of mechanical ventilation. Crit Care Med. 2005;33(6):1266-1271.

  10. Kahn JM, Rubenfeld GD, Rohrbach J, Fuchs BD. Cost savings attributable to reductions in intensive care unit length of stay for mechanically ventilated patients. Med Care. 2008;46(12):1226-33.

  11. Jackson DL, Proudfoot CW, Cann KF, Walsh T. A systematic review of the impact of sedation practice in the ICU on resource use, costs and patient safety. Crit Care. 2010;14(2):R59.

  12. Nseir S, Makris D, Mathieu D, Durocher A, Marquette CH. Intensive care unit-acquired infection as a side effect of sedation. Crit Care. 2010;14(2):R30.

  13. Reardon DP, Anger KE, Adams CD, Szumita PM. Role of dexmedetomidine in adults in the intensive care unit: an update. Am J Health Syst Pharm. 2013;70(9):767-777.

  14. Gerlach AT, Murphy CV, Dasta JF. An updated focused review of dexmedetomidine in adults. Ann Pharmacother. 2009;43(12):2064-2074.

  15. Chrysostomou C, Schmitt CG. Dexmedetomidine: sedation, analgesia and beyond. Expert Opin Drug Metab Toxicol. 2008;4(5):619-627.

  16. Arcangeli A, D’Alo C, Gaspari R. Dexmedetomidine use in general anaesthesia. Curr Drug Targets. 2009;10(8):687-695.

  17. Riker RR, Shehabi Y, Bokesch PM, et al. SEDCOM (Safety and Efficacy of Dexmedetomidine Compared With Midazolam) study Group. Dexmedetomidine versus midazolam for sedation of critically ill patients: a randomized trial. JAMA. 2009;301(5):489-499.

  18. Ruokonen E, Parviainen I, Jakob SM, et al. “Dexmedetomidine for continuous sedation” investigators. Dexmedetomidine versus propofol/midazolam for long-term sedation during mechanical ventilation. Intensive Care Med. 2009;35(2):282-290.

  19. Pandharipande PP, Pun BT, Herr DL, et al. Effect of sedation with dexmedetomidine versus lorazepam on acute brain dysfunction in mechanically ventilated patients: the MENDS randomized controlled trial. JAMA. 2007;298(22):2644-2653.

  20. Venn RM, Grounds RM. Comparison between dexmedetomidine and propofol for sedation in the intensive care unit: patient and clinician perceptions. Br J Anaesth. 2001;87(5):684-690.

  21. Celis RE, Birchenall C, de la Cal MA, et al. Guía de práctica clínica basada en la evidencia para el manejo de la sedoanalgesia en el paciente adulto críticamente enfermo. Med Intensiva. 2013 Jun 14. [Epub ahead of print] Disponible en http://www.ncbi.nlm.nih.gov/pubmed/23773859

  22. Barr J, Fraser GL, Puntillo K, et al. American College of Critical Care Medicine. Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit. Crit Care Med. 2013;41(1):263-306.

  23. Szumita PM, Baroletti SA, Anger KE, Wechsler ME. Sedation and analgesia in the intensive care unit: evaluating the role of dexmedetomidine. Am J Health Syst Pharm. 2007;64(1):37-44.

  24. Dasta JF, Kane-Gill SL, Pencina M, et al. A cost-minimization analysis of dexmedetomidine compared with midazolam for long-term sedation in the intensive care unit. Crit Care Med. 2010;38(2):497-503.

  25. Portal de compras del Instituto Mexicano del Seguro Social [Internet]. [acceso 9 julio 2013] Disponible en: http://compras.imss.gob.mx/

  26. Costos unitarios por nivel de atención para 2013 en el Instituto Mexicano del Seguro Social. Diario Oficial de la Federación, 18 de abril de 2013, México.

  27. Briggs A, Claxton K, Sculpher M. Decision modeling for health economic evaluation. Oxford, UK: Oxford University Press; 2006.

  28. Lachaine J, Beauchemin C. Economic evaluation of dexmedetomidine relative to midazolam for sedation in the intensive care unit. Can J Hosp Pharm. 2012;65(2):103-110.

  29. MacLaren R, Sullivan PW. Economic evaluation of sustained sedation/analgesia in the intensive care unit. Expert Opin Pharmacother. 2006;7(15):2047-2068.




2020     |     www.medigraphic.com