This randomized, unblinded, multicenter pharmacoeconomic study characterized ICU sedation times, sedative costs, and other health care resource use to estimate the economic impact of adopting propofol in ICUs in Canada. Propofol was compared with midazolam for sedating patients in the ICU with differences in sedation quality and ICU length of stay assessed. Patients enrolled in the study were given either midazolam (n = 79) or propofol (n = 77) to reach an appropriate level of sedation. Eleven patients in the midazolam group and 15 in the propofol group died. Sedation failure occurred in 4 midazolam-treated patients and 7 propofol-treated patients. For the remaining 124 patients who survived and were discharged from the ICU, no difference was found in age or baseline hemodynamic parameters. Because tracheal extubation occurred while continuous sedation was ongoing in 25 patients, data for the primary outcome variables for the remaining 99 patients were analyzed. Although overall sedation duration was similar, propofol patients spent more time at adequately sedated status (60.2% vs. 44%) and were extubated faster (median extubation time, 2.5 vs. 7.1 hr). The total ICU length of stay was 69.8 hr for the propofol group and 72.7 hr for the midazolam-treated patients. Health resource use did not differ between the groups. The total cost per patient, including drug costs and ICU stay costs, did not differ between the groups. One sensitivity analysis indicated that the incremental cost per patient of propofol varies from an extra cost of $114 to a savings of $2,709. A second sensitivity analysis showed a potential savings of $479 per patient as a result of improved discharge planning. Using propofol resulted in a reduction of time to extubation and higher sedative regimen costs. Because there was no difference in intensity of resource use or ICU length of stay, there was no significant difference in costs. Issues regarding discharge delay among propofol-treated patients remain to be explored.
[1]
J. Leung,et al.
The Prevalence and Predictive Value of Abnormal Preoperative Laboratory Tests in Elderly Surgical Patients
,
2001,
Anesthesia and analgesia.
[2]
G. Ferzli,et al.
Cost effectiveness of routine type and screen testing before laparoscopic cholecystectomy
,
1999,
Surgical Endoscopy.
[3]
B. Baxter,et al.
Hospital-wide educational program decreases red blood cell transfusions.
,
1998,
The Journal of surgical research.
[4]
S. Ransom,et al.
A cost-effectiveness evaluation of preoperative type-and-screen testing for vaginal hysterectomy.
,
1996,
American journal of obstetrics and gynecology.
[5]
J. Allison,et al.
Unnecessary preoperative investigations: evaluation and cost analysis.
,
1996,
The American surgeon.
[6]
S. Cohen,et al.
The usefulness of preoperative laboratory screening.
,
1985,
JAMA.
[7]
B. Delahunt,et al.
How cost effective are routine preoperative investigations?
,
1980,
The New Zealand medical journal.