Pharmacoeconomic modeling of lorazepam, midazolam, and propofol for continuous sedation in critically ill patients
Pharmacoeconomic modeling of lorazepam, midazolam, and propofol for continuous sedation in critically ill patients
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DOI：
10.1592/phco.2005.25.10.1319
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发表时间：
2005-10-01
期刊：
影响因子：
4.1
通讯作者：
Sullivan, PW
中科院分区：
文献类型：
--
作者：
MacLaren, R;Sullivan, PW
研究目的。比较重症监护病房中丙泊酚、劳拉西泮和咪达唑仑短期、中期和长期镇静（分别为<24、24 - 72和> 72小时）的预期成本。通过使用与药物管理和不良事件（包括人员时间）相关的机构成本，为每种镇静剂和每种持续时间构建决策分析模型。成本以2002年美元表示。不良事件包括激越、高血糖和/或胰腺炎、低血压、营养变化、呼吸机相关性肺炎、长时间觉醒和/或拔管。检索MEDLINE和EMBASE数据库以获得镇静持续时间、结局发生率和结局成本估计。假设镇静剂维持特定镇静水平的能力等同。进行单变量敏感性分析以确定成本驱动变量，并使用二阶蒙特卡罗模拟进行概率敏感性分析。50项研究的加权平均镇静持续时间为13.46（短期）、45.27（中期）和119.78（长期）小时。劳拉西泮、咪达唑仑和丙泊酚镇静的预期成本分别为短期497美元、294美元和272美元;中期932美元、587美元和674美元;长期1604美元、1737美元和2033美元。丙泊酚在86%的短期模拟中成本最低，咪达唑仑在97.5%的中期模拟中成本最低，劳拉西泮在84%的长期模拟中成本最低。所有镇静剂最重要的成本驱动因素是药物成本。镇静后延长拔管时间是劳拉西泮和咪达唑仑的重要成本驱动因素，尤其是镇静时间延长时。丙泊酚、咪达唑仑和劳拉西泮分别具有最低的短期、中期和长期镇静预期成本。除药物成本外，还有许多因素影响镇静剂的成本。
Study Objective. To compare the expected costs of short-, intermediate-, and long-term sedation (< 24, 24-72, and > 72 hrs, respectively) with propofol, lorazepam, and midazolam in an intensive care unit.Methods. Decision-analysis models were constructed for each sedative and each duration by using institutional costs associated with drug administration and adverse events (including personnel time). Costs were A expressed in 2002 U.S. dollars. Adverse events were agitation, hypertriglyceridemia and/or pancreatitis, hypotension, nutritional changes, ventilator-associated pneumonia, and prolonged awakening and/or extubation. MEDLINE and EMBASE databases were searched to obtain durations of sedation, the incidence of outcomes, and cost estimates of outcomes. The ability to maintain specific levels of sedation was assumed equivalent among the sedatives. Univariate sensitivity analyses were conducted to determine the cost-driving variables, and probabilistic sensitivity analyses were conducted by using second-order Monte Carlo simulations.Results. Weighted mean durations of sedation from 50 studies were 13.46 (short term), 45.27 (intermediate term), and 119.78 (long term) hours. Expected costs for sedation with lorazepam, midazolam, and propofol, respectively, were $497, $294, and $272 short term; $932, $587, and $674 intermediate term; and $1604, $1737, and $2033 long term. Propofol was least costly in 86% of the short-term simulations, midazolam was least costly in 97.5% of the intermediate-term simulations, and lorazepam was least costly in 84% of the long-term simulations. The most important cost-driver for all sedatives was drug cost. Prolonged extubation after sedation was an important cost-driver for lorazepam and midazolam, especially as sedation was lengthened.Conclusion. Propofol, midazolam, and lorazepam had the lowest expected costs for short-, intermediate-, and long-term sedation, respectively. Many factors aside from drug costs influenced the cost of sedation.