A comprehensive 6-month economic evaluation of sedative options for mechanically ventilated patients found that dexmedetomidine, clonidine, and propofol may demonstrate similar costs and quality-adjusted life-years.
The within-trial cost-utility analysis, published in JAMA Network Open to coincide with presentation at the American Thoracic Society (ATS) 2025 International Conference, examined data from the A2B trial, which involved 1,404 adult patients with critical illness receiving mechanical ventilation across 41 intensive care units in the United Kingdom. The study population had a mean age of 59.2 years, was 64.2% male, and had a mean Acute Physiology and Chronic Health Evaluation II score of 20.3.
"The incremental cost for dexmedetomidine vs propofol was $1,273 (95% confidence interval [CI] = −$5,000 to $7,545), and for clonidine vs propofol, it was −$1,328 (95% CI = −$7,114 to $4,459)," reported the study authors. "For dexmedetomidine vs propofol, there were 0.0008 quality-adjusted life-years (QALY) (95% CI = −0.0198 to 0.0214 QALYs) gained, and for clonidine vs propofol, there were −0.0019 QALYs (95% CI = −0.0221 to 0.0181 QALYs) gained."
The analysis, conducted from a UK National Health Service and Personal Social Services perspective with costs calculated in UK pounds and converted to U.S. dollars (£1 = $1.25), was led by Stephen Morris, PhD, of the University of Cambridge, and colleagues. They followed the primary A2B trial, which found that neither dexmedetomidine- nor clonidine-based intravenous (IV) sedation was superior to propofol-based sedation in reducing time to successful extubation.
Mean net monetary benefits were calculated at a maximum willingness to pay of $16,250 per QALY, with similar values observed across all three sedation strategies: −$53,278 for dexmedetomidine, −$50,882 for clonidine, and −$52,036 for propofol. At this threshold, the probability that each option was cost-effective was 0.15 for dexmedetomidine, 0.56 for clonidine, and 0.29 for propofol.
The total costs per participant over the 6-month period were $55,423 for dexmedetomidine, $49,091 for clonidine, and $51,566 for propofol. A key finding was that study drugs accounted for less than 1% of total ICU costs, with the mean cost per participant of all 3 drugs up to 28 days being $169 for the dexmedetomidine group, $116 for clonidine, and $81 for the propofol group.
QALYs were estimated using utility scores from the 5-level EQ-5D (EQ-5D-5L) instrument collected at 30 days and 3 and 6 months. In the base case analysis assuming a baseline utility score of 0, mean total QALYs per participant up to 6 months were 0.08 in each of the 3 groups.
The study authors noted: "These findings suggest that IV sedation selection among dexmedetomidine, propofol, and clonidine should be based on individual patient need rather than economic considerations."
Multiple sensitivity analyses, including alternative baseline utility values and varying ICU costs, consistently showed no statistically significant differences in incremental costs or QALYs gained between the three sedation strategies.
Disclosures can be found in the study.
Source: JAMA Network Open