Clinical and economic impact of the use of dexmedetomidine for sedation in the intensive care unit compared to propofol
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RESEARCH ARTICLE
Clinical and economic impact of the use of dexmedetomidine for sedation in the intensive care unit compared to propofol Yoonsun Mo1,2 · Natalia Shcherbakova3 · John Zeibeq4 · Karina Muzykovsky2 · Wai Kin Li1 · James Gasperino4 Received: 4 April 2020 / Accepted: 8 July 2020 © Springer Nature Switzerland AG 2020
Abstract Background Despite the advantages of dexmedetomidine (DEX) over propofol (PRO) including minimal respiratory depression and the potential for preventing and/or treating intensive care unit (ICU) delirium, PRO has been the preferred agent due to its lower cost. However, the acquisition cost of DEX has considerably decreased as a generic version of DEX has recently become available. Objective To evaluate clinical and economic outcomes of DEX-based sedation compared to PRO in the ICU. Setting A retrospective cohort study of 86 ICU patients who received either DEX or PRO for a period ≥ 12 h. Method Patients were matched by age, sex, and Sequential Organ Failure Assessment scores in a 1:1 ratio. Main outcome measure Clinical outcomes included the duration of mechanical ventilation (MV), ICU and hospital length of stay (LOS), and requirements of concomitant sedatives and opioids. Economic outcomes included the ICU and hospital costs as well as the cost of sedatives or combined sedatives and opioids per patient. Results There were no significant differences in ICU and hospital LOS and time on MV in both groups (median ICU LOS 7 [DEX] vs. 9 [PRO] days, p = 0.07; median hospital LOS 12 [DEX] vs. 14 [PRO] days, p = 0.261; median time of MV 144 [DEX] vs. 158 [PRO] hours, p = 0.176). DEX-based sedation compared to PRO was associated with similar ICU and hospital costs (US$ 67,561 vs. 78,429, p = 0.39; US$ 71,923 vs. 71,084, p = 0.1). Conclusion The clinical outcomes and economic impact associated with DEX- and PRO-based sedation were similar. Keywords Dexmedetomidine · Intensive care unit · Propofol · Sedation strategies
Impact on practice • Both dexmedetomidine- and propofol-based sedation had An abstract was presented at the Society of Critical Care Medicine (SCCM) Critical CareCongress held on February 17–20, 2019 in San Diego, California. * Yoonsun Mo [email protected] 1
Arnold and Marie Schwartz College of Pharmacy and Health Sciences, Long Island University, 75 DeKalb Avenue, Brooklyn, NY 11201, USA
2
Pharmacy Department, The Brooklyn Hospital Center, 121 DeKalb Avenue, Brooklyn, NY 11201, USA
3
Western New England University College of Pharmacy, 1215 Wilbraham Road, Springfield, MA 01119, USA
4
Division of Critical Care Medicine, Department of Medicine, Center for Critical Care Services, The Brooklyn Hospital Center, 121 DeKalb Avenue, Brooklyn, NY 11201, USA
a similar impact on clinical outcomes, including safety. Moreover, use of either agent seems to affect the pharmacy budget and healthcare system equally. • The present study suggests either dexmedetomidine or propofol can be used as the first-line sedative medication for ICU patients, although further studies
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