COMMENTARY

ICU Costs Associated With Dexmedetomidine vs Midazolam Sedation

Greg Martin, MD

Disclosures

May 10, 2010

A Cost-Minimization Analysis of Dexmedetomidine Compared With Midazolam for Long-term Sedation in the Intensive Care Unit

Dasta JF, Kane-Gill SL, Pencina M, et al
Crit Care Med.2010;38:497-503

Study Summary

The standard approach to the management of mechanically ventilated adult patients in the intensive care unit (ICU) is the use of intermittent or continuous sedatives and analgesics. However, these medications have a variety of side effects, and their use may contribute substantially to healthcare costs. The investigators sought to compare the ICU costs of sedation with dexmedetomidine vs sedation with midazolam and to identify factors that influence these costs in mechanically ventilated patients. The data for analysis came from 366 intubated ICU patients from 68 ICUs in the United States, Australia, New Zealand, Brazil, and Argentina who were randomly assigned (2:1) to either continuous intravenous dexmedetomidine or midazolam.[1] Including drug acquisition cost, sedation with dexmedetomidine was associated with a median total ICU cost savings of $9679 (confidence interval, $2314-$17,045) compared with midazolam. The primary cost drivers were reduced costs of ICU stay (median savings, $6584) and reduced costs of mechanical ventilation (median savings, $2958). The investigators concluded that continuous sedation with dexmedetomidine is significantly less expensive than midazolam, primarily because of shorter ICU stay and fewer days of mechanical ventilation.

Viewpoint

Dexmedetomidine (Precedex®) is an alpha-2 agonist with sedative, sympatholytic, and analgesic-sparing properties that is US Food and Drug Administration (FDA) approved for up to 24 hours of use. Recent data suggest that dexmedetomidine may be safe to administer beyond 24 hours and in dosages up to 1.4 µg/kg/hr.[2,3] The Safety and Efficacy of Dexmedetomidine Compared with Midazolam (SEDCOM) study, from which the current substudy data were analyzed, randomly assigned 375 mechanically ventilated ICU patients to receive dexmedetomidine or midazolam. Patients who received dexmedetomidine experienced less delirium, fewer nosocomial infections, less tachycardia and hypertension (but more bradycardia), and a shorter time to extubation than patients treated with midazolam.[1] From these data, it appears that the use of dexmedetomidine may be more cost effective, despite higher drug acquisition costs, than the commonly used benzodiazepine anxiolytic medications. Because these are among the only data to assess the cost of such a strategy, and the patients in the underlying SEDCOM trial were required to receive sedation by continuous infusion, it will be important to have confirmation of these results and to ensure their application in a real-world setting.

Abstract

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