| Title |
Propofol or benzodiazepines for short- and long-term sedation in intensive care units? An economic evaluation based on meta-analytic results
|
|---|---|
| Published in |
ClinicoEconomics and Outcomes Research: CEOR, November 2017
|
| DOI | 10.2147/ceor.s136720 |
| Pubmed ID | |
| Authors |
Lorenzo Pradelli, Massimiliano Povero, Hartmut Bürkle, Tim-Gerald Kampmeier, Giorgio Della-Rocca, Astrid Feuersenger, Jean-Francois Baron, Martin Westphal |
| Abstract |
This evaluation compares propofol and benzodiazepine sedation for mechanically ventilated patients in intensive care units (ICUs) in order to identify the potential economic benefits from different payers' perspectives. The patient-level simulation model incorporated efficacy estimates from a structured meta-analysis and ICU-related costs from Italy, Germany, France, UK, and the USA. Efficacy outcomes were ICU length of stay (LOS), mechanical ventilation duration, and weaning time. We calculated ICU costs from mechanical ventilation duration and ICU LOS based on national average ICU costs with and without mechanical ventilation. Three scenarios were investigated: 1) long-term sedation >24 hours based on results from randomized controlled trials (RCTs); 2) long-term sedation based on RCT plus non-RCT results; and 3) short-term sedation <24 hours based on RCT results. We tested the model's robustness for input uncertainties by deterministic (DSA) and probabilistic sensitivity analyses (PSA). In the base case, mean savings with propofol versus benzodiazepines in long-term sedation ranged from €406 (95% confidence interval [CI]: 646 to 164) in Italy to 1,632 € (95% CI: 2,362 to 880) in the USA. Inclusion of non-RCT data corroborated these results. Savings in short-term sedation ranged from €148 (95% CI: 291 to 2) in Italy to €502 (95% CI: 936 to 57) in the USA. Parameters related to ICU and mechanical ventilation had a stronger influence in the DSA than drug-related parameters. In PSA, propofol reduced costs and ICU LOS compared to benzodiazepines in 94%-100% of simulations. The largest savings may be possible in the UK and the USA due to higher ICU costs. Current ICU sedation guidelines recommend propofol rather than midazolam for mechanically ventilated patients. This evaluation endorses the recommendation as it may lead to better outcomes and savings for health care systems, especially in countries with higher ICU-related costs. |
X Demographics
The data shown below were collected from the profiles of 3 X users who shared this research output. Click here to find out more about how the information was compiled.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| Sudan | 1 | 33% |
| Unknown | 2 | 67% |
Demographic breakdown
| Type | Count | As % |
|---|---|---|
| Members of the public | 3 | 100% |
Mendeley readers
The data shown below were compiled from readership statistics for 49 Mendeley readers of this research output. Click here to see the associated Mendeley record.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| Unknown | 49 | 100% |
Demographic breakdown
| Readers by professional status | Count | As % |
|---|---|---|
| Researcher | 9 | 18% |
| Other | 5 | 10% |
| Student > Bachelor | 5 | 10% |
| Student > Postgraduate | 4 | 8% |
| Student > Master | 4 | 8% |
| Other | 8 | 16% |
| Unknown | 14 | 29% |
| Readers by discipline | Count | As % |
|---|---|---|
| Medicine and Dentistry | 14 | 29% |
| Nursing and Health Professions | 5 | 10% |
| Social Sciences | 2 | 4% |
| Pharmacology, Toxicology and Pharmaceutical Science | 2 | 4% |
| Business, Management and Accounting | 1 | 2% |
| Other | 8 | 16% |
| Unknown | 17 | 35% |
Attention Score in Context
This research output has an Altmetric Attention Score of 6. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 10 April 2019.
All research outputs
#6,401,978
of 25,461,852 outputs
Outputs from ClinicoEconomics and Outcomes Research: CEOR
#126
of 525 outputs
Outputs of similar age
#96,270
of 341,042 outputs
Outputs of similar age from ClinicoEconomics and Outcomes Research: CEOR
#3
of 13 outputs
Altmetric has tracked 25,461,852 research outputs across all sources so far. This one has received more attention than most of these and is in the 74th percentile.
So far Altmetric has tracked 525 research outputs from this source. They typically receive a lot more attention than average, with a mean Attention Score of 12.0. This one has done well, scoring higher than 75% of its peers.
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We're also able to compare this research output to 13 others from the same source and published within six weeks on either side of this one. This one has done well, scoring higher than 76% of its contemporaries.