OBJECTIVES: To evaluate costs associated with the use of dexmedetomidine in comparison with conventional clinical practice in Portugal in intensive care unit (ICU) patients through a cost-minimisation and a budget impact analysis. METHODS: The population consisted of ICU mechanical ventilated patients requiring a mild to moderate level of sedation. Time spent at ICU was estimated based on a head-to-head published clinical trial (PRODEX) comparing the two sedatives. The time horizon was inpatient stay at ICU considering three periods: mechanical ventilation, non-invasive mechanical ventilation and off mechanical ventilation. The analysis considered the Portuguese National Health Service perspective and only included ICU stay and sedative costs, which were extracted from Portuguese official sources (2014 prices). Sensitivity analyses were performed. RESULTS: The estimated mean costs per ICU patient discharge were €13,950 for dexmedetomidine and €14,711 for propofol resulting in a cost-saving of €761 per patient. Sensitivity analysis confirmed savings upon the use of dexmedetomidine ranging from €598 to €1,418. Introducing dexmedetomidine in hospitals for sedation in ICU would result in yearly savings of at least €457K for the Portuguese NHS. CONCLUSIONS: Dexmedetomidine reduces the duration of mechanical ventilation and is a cost-saving alternative to propofol at the ICU setting.