Economic evaluation of remifentanil-based versus conventional sedation for patients with an anticipated mechanical ventilation duration of 2–3 days in Germany

Introduction

Hospitals are increasingly forced to consider the economics of technology use. We estimated the incremental cost-consequences of remifentanil-based sedation (RS) versus conventional sedation (CS) in ICU patients with an anticipated mechanical ventilation (MV) time of 2–3 days for Germany.

Methods

A probabilistic Markov model was utilized that describes the patient flow on the ICU using eight model states: MV – maintenance, MV – eligible start weaning, MV – actual weaning started, MV – eligible for extubation, ICU – extubated, ICU – eligible for discharge, Discharged from ICU, and Death. At every hour, patients stay at the current state, move to the next state, or die. The respective transition probabilities and the utilization of sedation drugs were derived from UltiSAFE, a Dutch open-label trial with 205 critically ill patients. In UltiSAFE, patients either received CS (predominantly morphine or fentanyl combined with propofol or midazolam) or RS (remifentanil, combined with propofol if required). Unit prices for drugs and total costs per ICU-hour with and without MV were collected in one 12-bed adult mixed ICU in a general German hospital. Material, staff and overhead costs were considered. All costs were measured from a hospital perspective with 2006 as the reference year. According to the UltiSAFE target population, only patients who started weaning within 72 hours of the start of treatment were included.

Results

The average duration of MV and of ICU stay was shorter, 0.9 and 0.8 days respectively, in the RS group compared with the CS group, while the average costs per patient were €6,157 in the RS group versus €7,160 in the CS group. The savings caused by the shorter length of stay therefore more than offset the additional drug acquisition costs, leading to €1,003 savings per patient in the RS group. The probability of RS being cost-saving was estimated at 91%.

Conclusion

RS seems to be the economically preferred option for patients with an anticipated MV time of 2–3 days: RS decreases the length of stay in the ICU, the total costs per patient and the duration of MV, which is a risk factor for ventilator-associated morbidity.