Cost-Minimization Analysis of Dexmedetomidine Compared to Other Sedatives for Short-Term Sedation During Mechanical Ventilation in the United States [Corrigendum]

Figures & data

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 Prevention^22
Length of stay in ICU (days)	1.9	3.0	3.0	Maldonado et al^18
Duration of MV (days)	0.496	0.463	0.529	Intubation time, Maldonado et al^18
Sedative
Treatment duration (hours)	13	11	10	Maldonado et al^18
% that receive loading dose (%)	100	0	0	Assumption based on study protocol, Maldonado et al^18
Loading dose (µg/kg)	0.4	–	–
Duration of loading dose (min)	10	–	–	Assumption based on prescribing information^24
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 al^18
Time to prepare one bag of sedative (seconds)^b	35	–	35	Assumption based on time to prepare one emergency syringe, Fraind et al^27 and Jelacic et al^41
Pain medication
Total dose of morphine (mg)	50.3	51.6	122.5	Maldonado et al^18
Adverse events
Occurrence of delirium (%)	10.0	44.4	42.5	ITT population, Maldonado et al^18

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 al^3
Day 2	$5989.35	Dasta et al^3
Day 3+	$5454.83	Dasta et al^3
MV, cost per day
Day 1	$7070.38	Dasta et al^3
Day 2	$2227.16	Dasta et al^3
Day 3+	$1343.15	Dasta et al^3
Sedative preparation
Pharmacist hourly rate	$55.23	Society of Critical Care Medicine^26
Respiratory monitoring costs
Arterial blood gases, per ICU day	$26.07	CPT 82,803, Blood gases any combination, CMS^28
Physician consultation cost, per ICU day	$226.80	CPT 99,291, Critical care first 30–74 minutes, CMS^29
Tracheal intubation cost, per ICU stay	$155.52	CPT 31,730, Introduction of indwelling tube for oxygen therapy^29
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 analyzers^28
Medication costs (wholesale acquisition cost per vial)
Dexmedetomidine	$42.00	200 µg vial, Truven Health Analytics^30
Midazolam	$1.92	50 mg vial, Truven Health Analytics^30
Midazolam	$0.55	5 mg vial for rescue sedation, Truven Health Analytics^30
Propofol	$3.88	500 mg vial, Truven Health Analytics^30
Morphine	$7.05	250 mg vial, Truven Health Analytics^30
Atropine, 0.5 mg per bradycardia event	$1.61	1 mg vial, Truven Health Analytics^30
Haloperidol, 10 mg per delirium event	$0.88	5 mg vial, Truven Health Analytics^30
Labetalol, 20 mg per hypertension event	$3.35	100 mg vial, Truven Health Analytics^30
Norepinephrine, 4 mg per hypotension event	$4.60	4 mg vial, Truven Health Analytics^30
Cefazolin, 1 g per infection event	$6.33	2 g vial, Truven Health Analytics^30

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 al^18
Duration of MV (days)	0.23	0.50	0.25	0.54	Djaiani et al,^14 Srivastava et al^15
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 al^15
% 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 al^15
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 al^15
Duration of loading dose (minutes)a	10.00	20.00	0.00	15.00	Herr et al,^19 Maldonado et al,^18 Srivastava et al^15
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 al^15
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 Linden^42
Rescue sedation, midazolam
% that receive rescue sedation (%)	0	100	0	100	Corbett et al,^32 Maldonado et al,^18 Srivastava et al^15
Rescue sedative dose (mg)	0	1.5	0	1	Corbett et al,^32 Maldonado et al,^18 Srivastava et al^15
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 al^15
Total dose of morphine (mg)	2.95	50.30	6.00	51.60	Corbett et al,^32 Herr et al,^19 Maldonado et al^18
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 al^15
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 al^15
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 al^15
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 al^15
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 al^15

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 al^18
Duration of MV (days)	0.19	0.50	0.52	0.54	Azeem et al,^13 Srivastava et al,^15 Wan et al^16
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 al^16
% that receive loading dose (%)	0%	100%	0%	100%	Azeem et al,^13 Maldonado et al,^18 Srivastava et al,^15 Wan et al^16
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 al^16
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 al^16
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 al^16
Time to prepare one bag of sedative (sec)c	25	115	25	115	Fraind et al,^27 Jelacic et al,^41 van der Linden^42
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 al^16
Rescue sedative dose (mg)	0	6.7	–	–	Azeem et al,^13 Maldonado et al,^18 Srivastava et al,^15 Wan et al^16
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 al^16
Total dose of morphine (mg)	17.61	50.30	37.21	125.06	Azeem et al,^13 Maldonado et al,^18 Wan et al^16
Adverse events
Occurrence of bradycardia (%)	0	25	0	10	Azeem et al,^13 Maldonado et al,^18 Srivastava et al,^15 Wan et al^16
Occurrence of delirium (%)	0	10	0	43	Maldonado et al,^18 Srivastava et al^15
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 al^16
Occurrence of hypotension (%)	0	28	0	11	Azeem et al,^13 Maldonado et al,^18 Srivastava et al,^15 Wan et al^16
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 al^16

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.