Cost-effectiveness analysis of dexmedetomidine versus propofol for sedation in mechanically ventilated patients after cardiovascular surgery; an institutional perspective

Objectives: Dexmedetomidine and propofol are commonly used for sedation after cardiovascular surgery. Coronary artery bypass graft and/or aortic/mitral valve surgeries are often fast tracked to extubation and require short term sedation. Dexmedetomidine and propofol have attractive pharmacokinetic profiles that make them excellent sedative agents in this patient population, but there is a significant difference in their cost. Despite increased use of dexmedetomidine in the ICU setting, there is limited data directly comparing both agents from a cost perspective in cardiovascular surgery patients. This study will analyze the cost-effectiveness of dexmedetomidine versus propofol for sedation in mechanically ventilated patients after cardiovascular surgery from an institutional perspective.

Methods: Efficacy and safety data were used from a previously conducted trial comparing dexmedetomidine and propofol at our institution. Duration of mechanical ventilation after surgery, addition of a second agent for sedation, and incidence of delirium while on sedation were the efficacy and safety endpoints used in this analysis. Corresponding medication costs, cost of mechanical ventilation and cost associated with delirium were also accounted for in our analysis. Data was analyzed by TreeAge Software to create a pharmacoeconomic decision tree that determined the most cost effective option for sedation.

Results: The average cost of sedation for patients receiving dexmedetomidine was 1647 USD compared to 1849 USD for patients receiving propofol.  Results from a tornado analysis on all cost variables indicated that the cost associated with delirium had the most impact on overall cost outcomes. Findings from a sensitivity analysis varying the cost of delirium found no difference in end cost outcomes.

Conclusion: Dexmedetomidine was found to be the more cost-effective option for sedation in cardiovascular surgery patients compared to propofol.  Although the cost of dexmedetomidine was higher, it reduced time on mechanical ventilation and need for a second sedative agent.