A Cost Analysis of Alfentanil + Propofol vs Morphine + Midazolam for the Sedation of Critically Ill Patients

Morphine + midazolam and alfentanil + propofol are regimens offering well tolerated and effective sedation for critically ill patients. However, morphine + midazolam is associated with accumulation in these patients, resulting in prolonged recovery characteristics. Alfentanil+propofol, although more expensive, has a shorter elimination half-life, is not associated with accumulation problems and results in a rapid recovery. This study compared sedation quality, patient recovery characteristics and the cost of alfentanil + propofol and morphine + midazolam for sedating critically ill patients in the intensive care setting. 26 patients were randomly allocated to receive sedation with alfentanil + propofol (n = 17) or morphine + midazolam (n = 9). Outcome measures were the times until extubation, intensive care unit (ICU) transfer and final hospital discharge. Cost analysis assessed both drug-related costs, including drug acquisition and administration, and non-drug-related costs, including bed occupancy. Age, gender, diagnosis, Acute Physiological and Chronic Health Evaluation (APACHE) II scores and sedation quality did not differ significantly between groups. The times to extubation and until patients were fit for transfer from ICU were significantly shorter for patients sedated with alfentanil + propofol than for those sedated with morphine + midazolam. The total costs (at the time of the study Pounds 1 was equivalent to $US1.59) for ICU hospital stay per patient for alfentanil + propofol and morphine + midazolam were 3063 Pounds and 9511 Pounds, respectively, because the shorter recovery characteristics of alfentanil + propofol led to a reduction in ICU stay. Corresponding costss for total hospital stay were 6063 Pounds and 13735 Pounds, respectively. In conclusion, alfentanil + propofol has a better pharmacoeconomic profile than morphine + midazolam for sedating critically ill patients in the ICU setting.