Propofol or benzodiazepines for short- and long-term sedation in intensive care units? An economic evaluation based on meta-analytic results

Lorenzo Pradelli,1 Massimiliano Povero,1 Hartmut Bürkle,2 Tim-Gerald Kampmeier,3 Giorgio Della-Rocca,4 Astrid Feuersenger,5 Jean-Francois Baron,6 Martin Westphal5 1AdRes HE&OR, Torino, Italy; 2Department of Anaesthesiology and Critical Care Medicine, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, 3Clinic for Anesthesiology and Surgical Intensive Care Medicine, University Hospital Münster, Münster, Germany; 4Department of Anaesthesia and Intensive Care Medicine, Medical School of the University of Udine, Udine, Italy; 5Fresenius Kabi Deutschland GmbH, Bad Homburg, Germany; 6Fresenius Kabi ELAMA, Paris Cedex, France Purpose: 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. Methods: 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