OBJECTIVES: Dexmedetomidine, propofol, and midazolam are commonly used in the intensive care unit (ICU) to sedate mechanically ventilated patients in the United States. This study estimates the ICU, mechanical ventilation, treatment, and monitoring costs for individuals receiving dexmedetomidine compared to propofol or midazolam.

METHODS: A cost-minimization analysis was conducted from the hospital provider perspective. The costs associated with the use of dexmedetomidine compared to propofol or midazolam were evaluated for patients requiring sedation in the ICU. Clinical outcomes and healthcare resource utilization including ICU length of stay, duration of mechanical ventilation, treatment duration, use of rescue sedation and pain medication, and the occurrence of adverse events were obtained from clinical trials. Costs were estimated based on published literature and Medicare payment fee schedules and included costs associated with the ICU, mechanical ventilation, medications, adverse events, and monitoring. Medication errors rates and costs, as well as medication preparation time and costs, were estimated based on published literature and considered when comparing concentrate versus pre-mix formulations of dexmedetomidine.

RESULTS: In patients requiring short-term sedation (≤ 24 hours), the per-patient costs associated with dexmedetomidine were estimated to be $9,327 compared to $9,580 with propofol. The per-patient costs associated with dexmedetomidine compared to midazolam were estimated to be $11,037 and $10,240, respectively. The cost associated with sedative use was driven by time spent in the ICU and on mechanical ventilation. The introduction of a pre-mix formulation for dexmedetomidine was demonstrated to lead to increased savings due to improved workflow efficiency and a reduction in medication preparation errors.

CONCLUSIONS: Dexmedetomidine use for sedation was associated with reduced costs when compared to propofol and slightly increased costs when compared to midazolam. The main cost drivers were ICU length of stay and the duration of mechanical ventilation.