The Pharmacoeconomics of Managing Acute Agitation in the Emergency Department

What Do We Know and How Do We Approach It?

Esther W Chan; David McD Taylor; Jonathan C Knott; Danny Liew; David CM Kong


Expert Rev Pharmacoeconomics Outcomes Res. 2012;12(5):589-595. 

In This Article

Pharmacoeconomic Studies in the Emergency Department Setting

Based on the last three National Health Surveys, the number of Australians affected by behavioral problems is increasing (5.9%, 9.6% and 11.0% in 1995, 2001 and 2004–2005, respectively).[101,102] Consistent with these figures, there have been increasing numbers of mental health presentations to emergency departments (EDs), with an overall increase in general emergency presentations.[102]

Acute behavioral issues presenting to the ED include first-episode psychiatric presentations (including drug-induced behavioral problems and psychoses), situational crises, self harm and other drug and/or alcohol problems.[102] In many cases, such behavioral issues are accompanied by severe, acute agitation that may require drug sedation if de-escalation approaches and verbal interventions fail.[1] Based on neurochemical pathways, two classes of drugs have been commonly used to manage the acutely agitated ED patient – benzodiazepines and antipsychotics (conventional and atypical classes[2,3]).

Importantly, there are increasing pressures to justify the costs associated with the additional benefits provided by new or alternate treatments. Constrained government and institutional budgets and the insatiable demand for better drug or management options, continually force decision-makers to carefully consider their choices.[4]