Dexmedetomidine for Sedation in the ICU or PICU: A Review of Cost-Effectiveness and Guidelines
Rapid Response Report: Summary with Critical Appraisal
Sedation of ICU patients is often essential for ICU patients to maximize survival, reduce ICU and hospital stay, and facilitate mechanical ventilation. The standard of care for sedation includes benzodiazepine sedatives and propofol. These sedatives (notably benzodiazepines) are associated with an increased risk of agitation and delirium. It has been hypothesized that dexmedetomidine would be an appropriate alternative to traditional sedatives for maintaining light to moderate sedation. Dexmedetomidine is an alpha2-adrenergic agonist, and it is approved in Canada for intensive care unit sedation and conscious sedation. In January 2014, the Canadian Agency for Drugs and Technologies in Health (CADTH) reviewed the evidence on the clinical effectiveness of using dexmedetomidine for sedation in intensive-care unit. Based on the CADTH review, dexmedetomidine was found to be associated with decreased ICU stay and decreased time on mechanical ventilation. However, it was associated with higher rates of bradycardia than comparators.
Dexmedetomidine is available in 100 mcg/mL in a 2 mL glass vials at $45.21 per vial. At the maximum allowed daily dose, dexmedetomidine is more expensive than midazolam, lorazepam, and propofol (Appendix 1). However, it is not clear if the higher cost of dexmedetomidine is offset by its suggested benefits. The objective of this report is to review the cost-effectiveness and the available evidence-based guidelines for using dexmedetomidine for sedation the intensive care unit.
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