Cost effectiveness of a benzodiazepine vs a nonbenzodiazepine-based sedation regimen for mechanically ventilated, critically ill adults

Jul 6, 2014Journal of critical care

Cost effectiveness of benzodiazepine versus non-benzodiazepine sedation in critically ill adults on mechanical ventilation

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Abstract

The incremental cost-effectiveness ratio for using nonbenzodiazepine sedation instead of benzodiazepine sedation is $3406 to avert one ICU day while on mechanical ventilation.

Nonbenzodiazepine sedation resulted in higher drug costs ($1327) compared to benzodiazepine sedation ($65).
Total ICU costs were lower for nonbenzodiazepine sedation ($35,380) compared to benzodiazepine sedation ($45,394).
Sensitivity analysis indicated that benzodiazepine sedation would only be more cost-effective if the daily extubation rate exceeded 16% and the ICU discharge rate without mechanical ventilation surpassed 77%.
The incremental cost-effectiveness ratio was similar for both dexmedetomidine and propofol when compared to benzodiazepine sedation.

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PURPOSE: Nonbenzodiazepine sedation (eg, dexmedetomidine or propofol) may be more cost effective than benzodiazepine (BZ) sedation despite its higher acquisition cost.

MATERIALS AND METHODS: A cost effectiveness (CE) analysis of noncardiac surgery, critically ill adults requiring at least 1 day of mechanical ventilation (MV) and administered either BZ or non-BZ sedation, that cycled health states and costs daily using a Markov model accounting for daily MV use until intensive care unit (ICU) discharge, was conducted from a third-party perspective. Transition probabilities were obtained from a published meta-analysis, and costs were estimated from best evidence. Sensitivity analyses were run for all extubation and discharge probabilities, for different cost estimates and for the specific non-BZ administered.

RESULTS: When non-BZ rather than BZ sedation was used, the incremental cost-effectiveness ratio to avert 1 ICU day while MV or while either MV or non-MV was $3406 and $3136, respectively. The base-case analysis revealed that non-BZ sedation (vs BZ sedation) resulted in higher drug costs ($1327 vs $65) but lower total ICU costs (percent accounted for MV need): $35380 (71.0%) vs $45394 (70.6%). Sensitivity analysis revealed that BZ sedation would only be less costly if the daily rate of extubation was at least 16%, and the daily rate of ICU discharge without MV was at least 77%. The incremental CE ratio to avert 1 ICU day while MV or non-MV was similar between the dexmedetomidine and propofol non-BZ options.

CONCLUSIONS: Among MV adults, non-BZ sedation has a more favorable CE ratio than BZ sedation over most cost estimates.

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Cost effectiveness of a benzodiazepine vs a nonbenzodiazepine-based sedation regimen for mechanically ventilated, critically ill adults

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