A Cost-Minimization Analysis of Dexmedetomidine Compared With Midazolam For Long-Term Sedation In The Intensive Care Unit. F1000: "Changes Clinical Practice"

Michael C Banks; Lee Fleisher

Disclosures

Faculty of 1000 

Dasta JF, Kane-Gill SL, Pencina M, Shehabi Y, Bokesch PM, Wisemandle W, Riker RR
Crit Care Med 2010 Feb 38(2):497-503

Commentary from Faculty Members Michael C Banks and Lee Fleisher

Changes Clinical Practice: In ICUs that have a sedation-analgesia-delirium protocol, dexmedetomidine should be added to the formulary and utilized to combat delirium as well as decrease the amount of benzodiazepines given to the patient.

In these difficult economic times many hospitals work hard to cut costs so that they can maintain viability. Drug acquisition cost is one area where cuts are made. This study shows that when you look beyond drug acquisition costs, sedation with dexmedetomidine significantly reduces ICU care costs ($9679 in cost savings) compared to sedation with midazolam.

The average cost of a day in the ICU ranges from $3000 to $4000 (2003 dollars). The cost of mechanical ventilation (MV) can incrementally increase the cost by $1522 per day![1] Add to this the fact that up to 80% of MV patients develop delirium and the cost of an ICU stay can increase dramatically. In the Safety and Efficacy of Dexmedetomidine Compared to Midazolam (SEDCOM) study,[2] MV patients sedated with dexmedetomidine had less delirium and spent less time on the ventilator compared to MV patients treated with midazolam (3.7 days versus 5.6 days; P=0.01). This study is a pharmacoeconomic evaluation of the SEDCOM data. The authors evaluated the total post-randomization cost of ICU care: cost of ICU stay, cost of MV, cost of study medication and cost of treating adverse drug events. The results showed an adjusted cost saving of $9679 (2007 dollars) for patients in the dexmedetomidine arm. The authors noted that the major factor driving the cost savings was ICU stay and length of MV. Although the SEDCOM study did not show a significant difference in length of ICU stay, there was a trend towards a decrease in length of stay. A larger study size may have shown a greater difference in the length of stay. Two criticisms of the study are 1) there was no standardized vent weaning protocol in the SEDCOM trial (for further reading on this topic please see [3]), 2) midazolam is a drug that is known to be an independent risk factor for delirium.[3]

Abstract

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