Institute for Medical Technology Assessment, Erasmus University, Burg, Oudlaan 50, Rotterdam, 3062 PA, The Netherlands.
Crit Care. 2010;14(6):R195. doi: 10.1186/cc9313. Epub 2010 Nov 1.
Hospitals are increasingly forced to consider the economics of technology use. We estimated the incremental cost-consequences of remifentanil-based analgo-sedation (RS) vs. conventional analgesia and sedation (CS) in patients requiring mechanical ventilation (MV) in the intensive care unit (ICU), using a modelling approach.
A Markov model was developed to describe patient flow in the ICU. The hourly probabilities to move from one state to another were derived from UltiSAFE, a Dutch clinical study involving ICU patients with an expected MV-time of two to three days requiring analgesia and sedation. Study medication was either: CS (morphine or fentanyl combined with propofol, midazolam or lorazepam) or: RS (remifentanil, combined with propofol when required). Study drug costs were derived from the trial, whereas all other ICU costs were estimated separately in a Dutch micro-costing study. All costs were measured from the hospital perspective (price level of 2006). Patients were followed in the model for 28 days. We also studied the sub-population where weaning had started within 72 hours.
The average total 28-day costs were €15,626 with RS versus €17,100 with CS, meaning a difference in costs of €1474 (95% CI -2163, 5110). The average length-of-stay (LOS) in the ICU was 7.6 days in the RS group versus 8.5 days in the CS group (difference 1.0, 95% CI -0.7, 2.6), while the average MV time was 5.0 days for RS versus 6.0 days for CS. Similar differences were found in the subgroup analysis.
Compared to CS, RS significantly decreases the overall costs in the ICU.
Clinicaltrials.gov NCT00158873.
医院越来越被迫考虑技术使用的经济学。我们使用建模方法，估计了在重症监护病房（ICU）中需要机械通气（MV）的患者中，瑞芬太尼为基础的镇痛镇静（RS）与常规镇痛镇静（CS）相比的增量成本后果。
开发了一个马尔可夫模型来描述 ICU 中的患者流动情况。从荷兰临床研究 UltiSAFE 中得出从一个状态转移到另一个状态的每小时概率，该研究涉及 ICU 患者，预计 MV 时间为 2 至 3 天，需要镇痛和镇静。研究药物为：CS（吗啡或芬太尼与丙泊酚、咪达唑仑或劳拉西泮联合）或：RS（瑞芬太尼，当需要时与丙泊酚联合）。研究药物成本来自试验，而所有其他 ICU 成本则在荷兰微观成本研究中单独估计。所有成本均从医院角度（2006 年价格水平）进行衡量。在模型中，患者随访 28 天。我们还研究了在 72 小时内开始脱机的亚人群。
RS 的平均总成本为 28 天 15626 欧元，CS 为 17100 欧元，意味着成本差异为 1474 欧元（95%CI-2163，5110）。RS 组 ICU 平均住院时间为 7.6 天，CS 组为 8.5 天（差异为 1.0，95%CI-0.7，2.6），而 RS 组 MV 时间平均为 5.0 天，CS 组为 6.0 天。亚组分析也发现了类似的差异。
与 CS 相比，RS 可显著降低 ICU 的总体成本。
Clinicaltrials.gov NCT00158873。
