Abstract

Objectives

A multicenter randomized clinical trial in Hong Kong Accident and Emergency (AE setting. Determining their comparative cost-effectiveness will further provide an economic perspective to inform the choice of sedative in this setting.

Methods

This analysis used data from a randomized clinical trial conducted in Hong Kong AE perspective and a within-trial time horizon, using a decision-analytic model. Sensitivity analyses were also undertaken.

Results

In the base-case analysis, median total management costs associated with IM midazolam, haloperidol, and olanzapine were Hong Kong dollar (HKD) 1958.9 (US dollar [USD] 251.1), HKD 2504.5 (USD 321.1), and HKD 2467.6 (USD 316.4), respectively. Agitation management labor cost was the main cost driver, whereas drug costs contributed the least. Midazolam dominated over haloperidol and olanzapine. Probabilistic sensitivity analyses supported that midazolam remains dominant > 95% of the time and revealed no clear difference in the cost-effectiveness of IM olanzapine versus haloperidol (incremental cost-effectiveness ratio 667.16; 95% confidence interval −770.89, 685.90).

Conclusions

IM midazolam is the dominant cost-effective treatment for the management of acute agitation in the AE setting. IM olanzapine could be considered as an alternative to IM haloperidol given that there is no clear difference in cost-effectiveness, and their adverse effect profile should be considered when choosing between them.