Aggarwal J, Lustrino J, Stephens J, Morgenstern D, Tang WY. Clinicoecon Outcomes Res. 2020;12:389–397.
Table 1.
Key Model Input Parameters
| Parameter | Dexmedetomidine | Propofol | Midazolam | Data Source |
|---|---|---|---|---|
| Patient weight (kg) | 82.5 | 82.5 | 82.5 | Average weight of an adult in the US, Centers for Disease Control and Prevention22 |
| Length of stay in ICU (days) | 1.9 | 3.0 | 3.0 | Maldonado et al18 |
| Duration of MV (days) | 0.496 | 0.463 | 0.529 | Intubation time, Maldonado et al18 |
| Sedative | ||||
| Treatment duration (hours) | 13 | 11 | 10 | Maldonado et al18 |
| % that receive loading dose (%) | 100 | 0 | 0 | Assumption based on study protocol, Maldonado et al18 |
| Loading dose (µg/kg) | 0.4 | – | – | |
| Duration of loading dose (min) | 10 | – | – | Assumption based on prescribing information24 |
| Maintenance dose (µg/kg/hr or mg/kg/hr)a | 0.35 | 1.578 | 0.018 | Calculated dose for midazolam based on average patient weight used in model, Maldonado et al18 |
| Time to prepare one bag of sedative (seconds)b | 35 | – | 35 | Assumption based on time to prepare one emergency syringe, Fraind et al27 and Jelacic et al41 |
| Pain medication | ||||
| Total dose of morphine (mg) | 50.3 | 51.6 | 122.5 | Maldonado et al18 |
| Adverse events | ||||
| Occurrence of delirium (%) | 10.0 | 44.4 | 42.5 | ITT population, Maldonado et al18 |
Notes: aDexmedetomidine: µg/kg/hr; propofol and midazolam: mg/kg/hr; b200 µg/bag of dexmedetomidine; 50 mg/bag of midazolam.
Abbreviations: ICU, intensive care unit; ITT, intention-to-treat; LOS, length of stay; MV, mechanical ventilation; US, United States.
Table 2.
Cost Inputs
| Variables | Cost (2018) | Data Source |
|---|---|---|
| ICU room and board, cost per day | ||
| Day 1 | $11,421.91 | Dasta et al3 |
| Day 2 | $5989.35 | Dasta et al3 |
| Day 3+ | $5454.83 | Dasta et al3 |
| MV, cost per day | ||
| Day 1 | $7070.38 | Dasta et al3 |
| Day 2 | $2227.16 | Dasta et al3 |
| Day 3+ | $1343.15 | Dasta et al3 |
| Sedative preparation | ||
| Pharmacist hourly rate | $55.23 | Society of Critical Care Medicine26 |
| Respiratory monitoring costs | ||
| Arterial blood gases, per ICU day | $26.07 | CPT 82,803, Blood gases any combination, CMS28 |
| Physician consultation cost, per ICU day | $226.80 | CPT 99,291, Critical care first 30–74 minutes, CMS29 |
| Tracheal intubation cost, per ICU stay | $155.52 | CPT 31,730, Introduction of indwelling tube for oxygen therapy29 |
| Toxicology testing | ||
| Benzodiazepine testing cost, per ICU treatment day if primary sedative was midazolam, per ICU stay if midazolam is administered for rescue sedation only | $71.83 | CPT 80,307, Drug test by chemistry analyzers28 |
| Medication costs (wholesale acquisition cost per vial) | ||
| Dexmedetomidine | $42.00 | 200 µg vial, Truven Health Analytics30 |
| Midazolam | $1.92 | 50 mg vial, Truven Health Analytics30 |
| Midazolam | $0.55 | 5 mg vial for rescue sedation, Truven Health Analytics30 |
| Propofol | $3.88 | 500 mg vial, Truven Health Analytics30 |
| Morphine | $7.05 | 250 mg vial, Truven Health Analytics30 |
| Atropine, 0.5 mg per bradycardia event | $1.61 | 1 mg vial, Truven Health Analytics30 |
| Haloperidol, 10 mg per delirium event | $0.88 | 5 mg vial, Truven Health Analytics30 |
| Labetalol, 20 mg per hypertension event | $3.35 | 100 mg vial, Truven Health Analytics30 |
| Norepinephrine, 4 mg per hypotension event | $4.60 | 4 mg vial, Truven Health Analytics30 |
| Cefazolin, 1 g per infection event | $6.33 | 2 g vial, Truven Health Analytics30 |
Abbreviations: CMS, Centers for Medicare and Medicaid Services; CPT, current procedural code; ICU, intensive care unit; MV, mechanical ventilation.
Table 3.
Sensitivity Analysis Clinical Inputs for Propofol Comparison
| Parameters | Dexmedetomidine Arm | Propofol Arm | Data Source | ||
|---|---|---|---|---|---|
| Lower Value | Upper Value | Lower Value | Upper Value | ||
| Length of stay in ICU (days) | 0.96 | 1.90 | 0.96 | 3.00 | Corbett et al,32 Maldonado et al18 |
| Duration of MV (days) | 0.23 | 0.50 | 0.25 | 0.54 | Djaiani et al,14 Srivastava et al15 |
| Sedative | |||||
| Treatment duration relative to MV duration (± hours)a | −0.59 | 6.00 | −0.44 | −0.10 | Herr et al,19 Maldonado et al,18 Srivastava et al15 |
| % that receive loading dose (%) | 90 | 100 | 0 | 100 | Dexmedetomidine inputs did not vary in published literature, varied by 10% for analysis. Corbett et al,32 Djaiani et al,14 Herr et al,19 Maldonado et al,18 Srivastava et al15 |
| Loading dose (µg/kg or mg/kg/hr)a | 0.40 | 1.00 | 0.00 | 4.00 | Corbett et al,32 Djaiani et al,14 Herr et al,19 Maldonado et al,18 Srivastava et al15 |
| Duration of loading dose (minutes)a | 10.00 | 20.00 | 0.00 | 15.00 | Herr et al,19 Maldonado et al,18 Srivastava et al15 |
| Maintenance dose (µg/kg/hr or mg/kg/hr)b | 0.31 | 0.55 | 0.04 | 2.00 | Corbett et al,32 Djaiani et al,14 Srivastava et al15 |
| Time to prepare bag (200 µg) of dexmedetomidine or vial of propofol(seconds) | 25 | 115 | 0 | 59 | Fraind et al,27 Jelacic et al,41 van der Linden42 |
| Rescue sedation, midazolam | |||||
| % that receive rescue sedation (%) | 0 | 100 | 0 | 100 | Corbett et al,32 Maldonado et al,18 Srivastava et al15 |
| Rescue sedative dose (mg) | 0 | 1.5 | 0 | 1 | Corbett et al,32 Maldonado et al,18 Srivastava et al15 |
| Pain medication | |||||
| % treated with pain medication (%) | 90 | 100 | 90 | 100 | Inputs did not vary in published literature, varied by 10% for analysis. Corbett et al,32 Djaiani et al,14 Herr et al,19 Maldonado et al,18 Srivastava et al15 |
| Total dose of morphine (mg) | 2.95 | 50.30 | 6.00 | 51.60 | Corbett et al,32 Herr et al,19 Maldonado et al18 |
| Adverse events | |||||
| Occurrence of bradycardia (%) | 0 | 3 | 0 | 1 | Corbett et al,32 Djaiani et al,14 Herr et al,19 Maldonado et al,18 Srivastava et al15 |
| Occurrence of delirium (%) | 0 | 12 | 0 | 44 | Corbett et al,32 Djaiani et al,14 Herr et al,19 Maldonado et al,18 Srivastava et al15 |
| Occurrence of hypertension (%) | 0 | 12 | 0 | 4 | Corbett et al,32 Djaiani et al,14 Herr et al,19 Maldonado et al,18 Srivastava et al15 |
| Occurrence of hypotension (%) | 0 | 81 | 0 | 67 | Corbett et al,32 Djaiani et al,14 Herr et al,19 Maldonado et al,18 Srivastava et al15 |
| Occurrence of infection (%) | 0 | 10 | 0 | 10 | Inputs did not vary in published literature, varied by 10% for analysis. Corbett et al,32 Djaiani et al,14 Herr et al,19 Maldonado et al,18 Srivastava et al15 |
Notes: aDexmedetomidine: μg/kg; propofol: mg/kg/hr; bDexmedetomidine: μg/kg/hr; propofol: mg/kg/hr.
Abbreviations: ICU, intensive care unit; MV, mechanical ventilation.
Table 4.
Sensitivity Analysis Clinical Inputs for Midazolam Comparison
| Parameters | Dexmedetomidine Arm | Midazolam Arm | Data Source | ||
|---|---|---|---|---|---|
| Lower Value | Upper Value | Lower Value | Upper Value | ||
| Length of stay in ICU (days) | 1.90 | 2.73 | 3.00 | 4.23 | Azeem et al,13 Maldonado et al18 |
| Duration of MV (days) | 0.19 | 0.50 | 0.52 | 0.54 | Azeem et al,13 Srivastava et al,15 Wan et al16 |
| Sedative | |||||
| Treatment duration relative to MV duration (± hours) | −0.59 | 2.80 | −2.70 | −0.80 | Maldonado et al,18 Srivastava et al,15 Wan et al16 |
| % that receive loading dose (%) | 0% | 100% | 0% | 100% | Azeem et al,13 Maldonado et al,18 Srivastava et al,15 Wan et al16 |
| Loading dose (µg/kg or mg/kg)a | 0.00 | 1.00 | 0.00 | 0.04 | Azeem et al,13 Maldonado et al,18 Srivastava et al,15 Wan et al16 |
| Duration of loading dose (min) | 0.00 | 15.00 | 0.00 | 15.00 | Azeem et al,13 Maldonado et al,18 Srivastava et al,15 Wan et al16 |
| Maintenance dose (µg/kg/hr or mg/kg/hr)b | 0.35 | 0.72 | 0.02 | 0.44 | Azeem et al,13 Maldonado et al,18 Wan et al16 |
| Time to prepare one bag of sedative (sec)c | 25 | 115 | 25 | 115 | Fraind et al,27 Jelacic et al,41 van der Linden42 |
| Rescue sedation, midazolam | For the midazolam arm, considered in sensitivity analysis for the primary sedative | ||||
| % that receive rescue sedation (%) | 0 | 100 | – | – | Azeem et al,13 Maldonado et al,18 Srivastava et al,15 Wan et al16 |
| Rescue sedative dose (mg) | 0 | 6.7 | – | – | Azeem et al,13 Maldonado et al,18 Srivastava et al,15 Wan et al16 |
| Pain medication | |||||
| % treated with pain medication (%) | 90 | 100 | 90 | 100 | Inputs did not vary in published literature, varied by 10% for analysis. Azeem et al,13 Maldonado et al,18 Srivastava et al,15 Wan et al16 |
| Total dose of morphine (mg) | 17.61 | 50.30 | 37.21 | 125.06 | Azeem et al,13 Maldonado et al,18 Wan et al16 |
| Adverse events | |||||
| Occurrence of bradycardia (%) | 0 | 25 | 0 | 10 | Azeem et al,13 Maldonado et al,18 Srivastava et al,15 Wan et al16 |
| Occurrence of delirium (%) | 0 | 10 | 0 | 43 | Maldonado et al,18 Srivastava et al15 |
| Occurrence of hypertension (%) | 0 | 10 | 0 | 10 | Inputs did not vary in published literature, varied by 10% for analysis. Azeem et al,13 Maldonado et al,18 Srivastava et al,15 Wan et al16 |
| Occurrence of hypotension (%) | 0 | 28 | 0 | 11 | Azeem et al,13 Maldonado et al,18 Srivastava et al,15 Wan et al16 |
| Occurrence of infection (%) | 0 | 10 | 0 | 10 | Inputs did not vary in published literature, varied by 10% for analysis. Azeem et al,13 Maldonado et al,18 Srivastava et al,15 Wan et al16 |
Notes: aDexmedetomidine: μg/kg; midazolam: mg/kg; bDexmedetomidine: μg/kg/hr; midazolam: mg/kg/hr; c200 μg/bag of dexmedetomidine; 50 mg/bag of midazolam.
Abbreviations: ICU, intensive care unit; MV, mechanical ventilation.
Tables 1–4 on pages 391-394, the reference citations listed in the Data Source columns are incorrect. The correct Tables 1–4 are shown below.
Page 397, references 41 and 42 are missing from the reference list. These references are shown below.
41. Jelacic S, Craddick K, Nair BG, et al. Relative Costs of Anesthesiologist Prepared, Hospital Pharmacy Prepared and Outsourced Anesthesia Drugs. Journal of Clinical Anesthesia. 2017;36:178-183.
42. van der Linden P, Douchamps J, Schmitt C, Forget D. Ready-to-Use Injection Preparations versus Conventional Reconstituted Admixtures: Economic Evaluation in a Real-Life Setting. PharmacoEconomics. 2002;20(8):529-536.