Economic evaluation of propofol and lorazepam for critically ill patients undergoing mechanical ventilation.
Economic evaluation of propofol and lorazepam for critically ill patients undergoing mechanical ventilation.
复制标题
异丙酚和劳拉西泮对接受机械通气的危重患者的经济评价。
DOI：
10.1097/ccm.0b013e3181544248
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发表时间：
2008
影响因子：
8.8
通讯作者：
Carson,ShannonS
中科院分区：
文献类型：
--
作者：
Cox,ChristopherE;Reed,ShelbyD;Govert,JosephA;Rodgers,JoE;Campbell-Bright,Stacy;Kress,JohnP;Carson,ShannonS
目的：由于与特定镇静剂相关的成本和临床结果的差异，镇静选择在机械通气患者管理中的经济意义尚不清楚。因此，我们旨在确定机械通气危重患者最常用镇静剂的成本效益。设计、环境和患者：采用医院的视角，我们开发了一个概率决策模型，以确定连续异丙酚或间歇性劳拉西泮与每日醒来时是否具有更大的价值。我们还在二次分析中评估了连续咪达唑仑的比较价值。我们假设患者在医疗重症监护病房进行管理，预计需要通气≥48小时。模型输入来自随机对照试验数据、医学文献、医疗保险报销率、药房数据库和机构数据的初步分析。主要结果：我们以插管后前28天内每个无机械呼吸机日的成本来衡量成本效益。我们的基本案例概率分析表明，在91%的模拟中，丙泊酚占劳拉西泮的主导地位，平均每位患者的成本降低了6378美元，并且与3天以上的机械呼吸机无关。该模型没有揭示异丙酚和咪达唑仑在成本或有效性方面的临床有意义的差异。结论：异丙酚在需要机械通气的危重患者中应用于日常镇静中断，其镇静价值优于劳拉西泮。
Objective: The economic implications of sedative choice in the management of patients receiving mechanical ventilation are unclear because of differences in costs and clinical outcomes associated with specific sedatives. Therefore, we aimed to determine the cost-effectiveness of the most commonly used sedatives prescribed for mechanically ventilated critically ill patients.Design, Setting, and Patients: Adopting the perspective of a hospital, we developed a probabilistic decision model to determine whether continuous propofol or intermittent lorazepam was associated with greater value when combined with daily awakenings. We also evaluated the comparative value of continuous midazolam in secondary analyses. We assumed that patients were managed in a medical intensive care unit and expected to require ventilation for≥ 48 hrs. Model inputs were derived from primary analysis of randomized controlled trial data, medical literature, Medicare reimbursement rates, pharmacy databases, and institutional data.Main Results: We measured cost-effectiveness as costs per mechanical ventilator–free day within the first 28 days after intubation. Our base-case probabilistic analysis demonstrated that propofol dominated lorazepam in 91% of simulations and, on average, was both $6,378 less costly per patient and associated with more than three additional mechanical ventilator–free days. The model did not reveal clinically meaningful differences between propofol and midazolam on costs or measures of effectiveness.Conclusion: Propofol has superior value compared with lorazepam when used for sedation among the critically ill who require mechanical ventilation when used in the setting of daily sedative interruption.