The Pharmacoeconomics of Managing Acute Agitation in the Emergency Department

Authors and Disclosures

Esther W Chan¹, David McD Taylor², Jonathan C Knott³, Danny Liew⁴ and David CM Kong<sup>*5

1</sup>Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 2/F Laboratory Block, 21 Sassoon Road, Pokfulam, Hong Kong
²Emergency Department, Austin Health, Studley Road, Heidelberg, VIC 3084, Australia
³Emergency Department, Royal Melbourne Hospital, Grattan Street, Parkville, VIC 3050, Australia
⁴Melbourne EpiCentre (Centre for Clinical Epidemiology, Biostatistics and Health Services Research), The University of Melbourne and Royal Melbourne Hospital, Grattan Street, Parkville, VIC 3050, Australia
⁵Centre for Medicine Use and Safety, Monash University, 381 Royal Pde, Parkville, VIC 3052, Australia.

Financial & competing interests disclosure
The authors express gratitude for research support for EW Chan received from the Ian Scott PhD scholarship, Australian Rotary Health and the Postgraduate Publication Award, Monash University, Victoria. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.
No writing assistance was utilized in the production of this manuscript.

*Author for correspondence
Tel.: +61 3 9903 9035 Fax: +61 3 9903 9629 david.kong@monash.edu

Sidebar

Key Issues

• Emergency departments (EDs) manage acute behavioral issues including first-episode psychiatric presentations, drug-induced behavioral problems and psychoses. Management requires a disproportionate amount of ED staff time, attention and other resources.

• Despite the recognition of considerable resource implications, few pharmacoeconomic studies have compared sedating drugs for the management of acute agitation specifically in the ED setting.

• Pharmacoeconomic studies of acute agitation have almost all been conducted in the psychiatry setting and vary in depth and quality. Common study limitations include small sample sizes, loss to follow-up and other inherent issues upon which the pharmacoeconomic studies were based.

• From the perspective of emergency management and its economic considerations, the available literature (e.g., those available in the psychiatry setting) are not generalizable to the ED setting.

• Clinical trials comparing alternative sedating drugs offer a starting point for the collation of clinical and cost data. Other sources of these data may include observational studies, expert panels and institutional decision support departments.

• There are inherent difficulties in conducting pharmacoeconomic studies in acute agitation management in the ED. Conducting robust clinical trials into the management of acute agitation in the ED will facilitate pharmacoeconomic analyses and aid in the decision-making process in this area.