Cost-Effectiveness of α 2 Agonists for Intravenous Sedation in Patients With Critical Illness

作者：Stephen Morris, Nazir Lone, Cathrine McKenzie, Christopher J. Weir, Timothy Walsh, A2B trial investigators, Natalie Pattison, Barry Williams, Louise Rose, Paul Mouncey, John R. Prowle, David Wellsted, Timothy Walsh, Stephen J. Brett, Heather Charles, Christoper Weir, John Norrie, Julian Bion, Graeme McLennan, Matt Stevenson, Alistair Nichol, Timothy Walsh, Maria Amamio, Lucy Barclay, Sophie Birch, Kate Briton, Sarah A. Clark, J. Crossan, Katherine Doverman, David Hope, Lucy MacDonald, Corrienne McCulloch, Nikolas Rae, Scott A. Simpson, Jo Singleton, M Wishart, Ruth Thompson, Neill Aitken, Rachel Fairlie, Nabeel Salim, Sam Talbot, Sarah Ackroyd, Valeria Alicino, Euan Allan, Thomas W. Anderson, R. Gennery Andrew, Andrew Baigey, J. Kenneth Baillie, Calum Barnetson, Ruth Begbie, Richie Biggers, Michael Blaney, Richard Broom, David Birrell, Will Calkin, Keegan Chuavilong, R Cowden, Thomas Cox, Coral Darjee, Simon J. Davies, Annemarie Docherty, Luke Dornan, Mark Dunn, Stuart Edwardson, Ross Gillespie, John E. Greenwood, David Griffith, Alasdair W. Hay, Amy Hu, Ali Hunter, Karen Jones, Helen Jordan, Ancy Joseph, Kallirroi Kefala, Stephanie Kelly, Laura Kemp, Bara Kubanova, Victoria Leng, John H. Livesey, Nazir Lone, J. F. Lyon, O. T. Mansfield, D. Mcavoy, Aaron McClatchey, J.J. Miller, Ananda S. Mirchandani, Peter Moffitt, S.J. Morrison, A L Muir, Kieran Nunn, John Ochiltree, Emily Ogden, Matthew Parks, Marc Pass, Rachael Penrose, Harry Putnam, Thomas Quinn, Jonathan R. Rhodes, Alexander Rollings, Stephen Ross, R. P. W. Shackleton, Manu Shankar, Sunil Sharma, Iain Slessor, Zack Slevin, Duncan Stickle, Louise Symons, Fiona Walker, Luke Walls, Ian Whiteford, Sue Yin Yong, Neil Young, Kevin Rooney, Michael G. Kinsella, Brian Digby, Michael Brett, Paul McConnell, Mark J. Henderson, Radha Sundaram, Lisa Gemmell, Fiona Christie, Philip Henderson, Fiona B. MacGregor, Steven Henderson, Natalie Rodden, Kirsty Fallon, Lynn Abel, Barbara McLaren, E. D. Hughes, Deborah McGlynn, Nicola Thomson, Lauren Walker, Susan Currie, Natasha Parker, Donna Gillan, Farooq Brohi, Sarah Purvis, Michele Clark, Pam Race, Lynne Williams, Ahmed H. Shahin, Eusebius Nworah, Jonathan Gui, Li-Chin Cheng, Katelyn Stewart, Rebecca Cusack, Mark Tomlin, Clare Bolger, Rachel Burnish, Sue Jackson, Alice Baker, Jonathan Biss, Karen Salmon, Michael J. Carter, Cathrine McKenzie, Razaz Elsheikh, Missy Harrison, Charlotte Thomas, James Ward, Andrew F. Cumpstey, Ahilanandan Dushianthan, Ivan Kemp, Valérie Page, Xiaobei Zhao, Nazril Nordin, Ahmed N. Hegazy, Elvira Hoxha, Owen Hardaker, Chimenime Ede, Nailia Kotrikova, Acharya Devaraja, Thomas Stambach, Prasun Mukherjee, Mark Louie Guanco, Matt P. Wise, Jade Cole, Helen Hill, Jenny Brooks, Michelle Davies, Rhys Davies, Emma Thomas, Angharad Williams, Lauren Lodhi, Matt Morgan, Simon Ridler, Christopher K. Smith, Maria Faulkner, Alison Ivison, Laura McKay, Helen Jeffrey, Jude Price, Luke T. Slater, Angela Davies, Edward Hughes, Matt Thomas, Dominic Janssen, Ian Thomas, Kate Crewdson, Christopher Newell, Robert Hirst, Stephen H. West, Agnieszka Skorko, Emma Gendall, Ruth Worner, Beverley Faulkner, Borislava Borislavova, Kati Hayes, Andrew S. Parsons, Elizabeth Goff, John Sowersby, Annie Wood, K. J. Oglesby, Idrisu Sanusi, Charlie Pope, Andrew H. Baird, Hayley Blackmore, Robert Healey, Philip Hopkins, Eleanor Corcoran, Gillian Selman, Clare Finney, Evita Pappa, John Smith, Emma Clarey, Maeve Cockrell, Sian Saha, Harriet Noble, Kevin O’Reilly, Maria Depante, Anna Broderick, Marianette Anne Axalan, Burt Vergara, Reena Mehta, Henrik Reschrieter, Sarah Patch, Julie Camsooksai, Sarah M. Jenkins, Madga Pomichowska, Ken Power, Spike Briggs, Elizabeth Woodward, Christopher Loew, James Bromilow, James Keegan, Matthew Taylor, Emma Langridge, Dinesh Kulandhaisamy, Saah Savage, Yasmin DeAth, Charlotte Humphrey, Sue Roffe, Matthew Bayliss, Leanne Bartlett, Richard Gordon-Williams, Kate Tatham, Sam Smith, Isabel Noris, Sharjeel Tahir, Emma Yates, Shivali Patel, Tanith Westerman, Sekina Bakare, Hugh Furness, Emma Hunt, Reyhaneh Sadegh Zadeh, Maria Khan, William Sherwood, Claudio Addari, Roshni Manex, Nicole Ennis Whitehead, Fred Wilson, Luke Edwards, Kshiteeja Nalk, Sophie Biddle, Suzannah Lant, Francesca Holden, Shree Voralia, Nicola Ocean, Arun Sahni, Prakhar Srilastava, Sultan Iqbal, Shamil Tana, Vishal Venkat Raman, Zoszka Webb, Luke Parker, Arnold Dela Rosa, Miran Kadr, Eleanor Jones Harvey, Ryan Howle, Aatif M. Husain, Olivia Morley, Sarah Loftus, Jenna Hutchinson, Shaman Jhanji, Ethel Black, David H. Parkinson, R Raobaikady, Mark Borthwick, Christie James, Grace Polley, Neil Davidson, Sally Beer, Paula Hutton, Archana Bashyal, Jean Wilson, Soyamol Mathew, Jung Hee Ryu, Jason Cupitt, Gareth Hardy, Leonie Benham, Robert Downes, Neil Flint, Michael Little, Ravindra Pochiraju, Prematie Andreou, Dawn Hales, Jessica Hailstone, Megha Mathews, Martin Huntley, Lorraine Stephenson, Jacqui Hussey, H M Tan, S.P. Holbrook, Hayley Kemp, David J. Earl, Richard Innes, Benjamin Plumb, Patricia Doble, Rebecca Purnell, Ashly Thomas, Muhammad Noor, Waqas Khaliq, Micheal Jennings, Bernd Oliver Rose, Rosie Reece-Anthony, Sagira Khatun, Samantha Dickinson, Jayson Clarke, Charles L. Cox, Adam Longley, Tariq Ali, Babita Gurung, Mohamed Moubarak, Alan Williams, Jonathan Ball, Susannah Leaver, Sarah Farnell-Ward, Maria Thanasi, Shreeja Dangol, Vince Ventura, Massimiliano Valcher, Christine Sicat, Nikki Yun, Rebecca Kanu, Maria Maiz Cordoba, Ha Trinh, K.E. Lloyd, Romina Pepermans Saluzzio, Lijun Ding, Helen Farrah, Edna Fernandes, Chris Nutt, Jonathan A. Silversides, Danny McAuley, Peter McGuigan, Emmet Major, Elliott Lonsdale, Nerielle Fundano, Kathryn Ward, Christine B. Turley, Aisling O’Neill, Stephanie Finn, Jackie Green, Erin Collins, Julie McAuley, Jeanette Mills, Chris Wright, Michelle Growcott, Iain McCullagh, Stephen Wright, I Clement', Jonathan Shelton, Matthew Faulds, Thomas P Hellyer, H. J. V. Morton, Christopher Pollard, Christopher E. White, Leigh Dunn, Verity Calder, Susan Taylor, Pamela Garcia, Benjamin Brown, James Savage, Maite Babio-Galan, Kimberley Webster, Tessa Wilkinson, Arti Gulati, Tara Lal Shrestha, Carole Hays, Lauren Butler, Fatima Simoes, Margaret McNeil, Ian C. Storey, Simon Whiteley, Elizabeth Wilby, Susan Trott, Sarah Watts, Shailamma Mathew, Sheila Salada, Adam Neep, Nora Youngs, Clare Howcroft, Matthew Powell, Michael Adlam, Zoe Friar, David Antcliffe, Anthony Gordon, Dorota Banach, Roceld Rojo, Sonia Sousa Arias, Ziortza Fernández de Pinedo Artaraz, Phoebe Coghlan, Amal Mohammed, Eleanor Jepson, Jenny P. S. Wong, Anita Gurung, Caoimhe O’Dwyer, Sara Perez Guillotin, Maie Templeton, James Hanison, Jonathan Bannard‐Smith, Daniel Conway, Shoneen Abbas, Mohamed Ismail Aly, Stephen Benington, Teh Eng Hean, Daniel Hayley, Ellen McGuckin, Andrew Martin, Thomas F. Morris, William Musselbrook, Bhaskar Narayan, Thomas D. Wright, Chris Wheeler, Melanie Barker, Richard A. Clark, Emma Connaughton, R Jama, Deborah Paripoorani, Rachael Quayle, Anila Sukumaran, Charlotte Taylor, Megan Balmer, Saejohn Lingeswaran, L H Edmunds, Katharine Wylie, Andrew Owen, Gavin D. Perkins, Sean Munnelly, Daniel E. Park, Jo Gresty, Ellie Reeves, Celina Maliaykal, Teresa Melody, Jacobus Preller, Petra Polgarova, Cristina Bravoelvira, Sofia Teixeira, James Varley, Sapna Sharma Hajela, Kay Elston, Siobhan Campbell, Meike Keil, Muhammad Elbehery, Jocelyn R. Marshall, Susan C. Stevenson, Andrew Conway Morris, Prasad Gogineni Venkateskara, Michael Reay, Karen Reid, Rebecca Brown, Chinenyenwa Amareihe, Elliot Yates, Jing W Goh, Edward Jones, Aamer Mughal, David Brealey, Niall MacCallum, Samuel E. Clark, Deborah Smyth, Georgia Bercades, Ingrid Hass, Gladys Martir, Anna Reyes, Maria Alexandra Zapata Martinez, Laura Gallagher, Chi Yee Chung, Graeme Sanders, Vipal Chawla, Namrata Maheshwari, Tessa Glazebrook, Hollie Angel, Rebecca Squires, Hayley Dolan, Christopher Donnelly, Lucy Mires, Robert Musalagani, Suzanne T. Williams, Robin Heij, Peter Young, Mark Blunt, Gayathri Wijewardena, John Gibson, Aricsa Mariya Joshy, Jeremy Bewley, Kieron Rooney, Katie Sweet, Kim Wright, Lisa Grimmer, Denise Webster, Casandra Bazan Lacerot, Rachel Shiel, Eva Maria Hernandez Morano, Christina Coleman, Eleanor Daniel, O.O. Komolafe, Josephine Bonnici, Linda Pipira, Rebekah Johnson, Anna Chillingworth, Yahui Liang, Georgia Efford, Angeliki Kolovou, George Davies, Zoe Garland, Bethany Gumbrill, Ivan Collin, Matthew Gibbins, Thomas Brougham, Daniel Harvey, William R. Phipps, Kathryn Harrold, Nick Plummer, Ben Lowe, Paul D. James, Sarah Ahmed, Rukmini Ghosh, Mohamed Omer, Tuhin Subhra Santra, J. Shilston, Andrew Russell, Viresh Patel, Upasana Topiwala, Habideen Bello, Julia Sampson, Lucy Ryan, Cecilia Peters, Megan Meredith, Louise Conner, Lucy Morris, Amy Clark, Alice Baddeley, L. McLoughlin, Cate Walton, Treesa Joseph, Anju Thomas, Sophie Lubbock, David A. Ford, Alexandra McCoy, Tony N’Dungu, Ingeborg Welters, Vinoth Sankar, Alicia Waite, Brian Johnston, David Shaw, Vicki Waugh, Karen Williams, Maria Lopez Martinez, Maria Norris, Maria Arra Carlota Mahiya, Jamie Fernandez Roman, Jing Yuan, Silvia Manes, Caitlin Lythgoe, Ibrahim Almafreji, Josh Colfar, Laura Medhurst, Stephanie Beresford, Sofia Farina, Lema Imam, Syamlam Ali, Zachary M. Thomas, Francesca Bold, Katherine Hodson, Aleem Morenikeji, Daniel Watkin, Tamás Szakmány, Amy Cardwell, Anne Frawley, Marlies Ostermann, Gillian Radcliffe, Nicholas Barrett, Simon Sparkes, Adam Woodman-Bailey, Eirini Kosifidou, Aneta Bociek, Ellie Hendrie, Rosario Lim, Fabiola D’Amato, Sarah Fordyce, Benjie Cendreda, Kyma Morera Vas, Jacqueline Pan, Christopher Meddings, Veljko Milić, Mike Barker, Jennifer Owusu-Afriyie, Carolin Engelhard, Malcolm Sim, Richard Appleton, Maximilian Ralston, Andrew Arnott, Izabela Orlikowska, Sophie Kennedy-Hay, Christopher Murray, Matthew Devine, Padraig Headley, John McCaffrey, Daniel Donnelly, Richard E. Young, Samantha Hagan, Victoria Adell, Elizabeth Murphy, Jian Quek, Stephen Wilson, Catherine Jardine, Mark Forrest, Emma Collins, Mohamed Izham Mohamed Ibrahim, Mark Wheeley, Mostafa Kodous, Mathew Blake, Victoria Lacey, Michael Eager, Robin Jootun, Janine Birch · 发表于：JAMA Network Open · 年份：2025 · DOI：10.1001/jamanetworkopen.2025.17533 · 被引用次数：3 · 研究领域：Intensive Care Unit Cognitive Disorders、Anesthesia and Sedative Agents、Respiratory Support and Mechanisms

Importance: Propofol and the α2 agonists dexmedetomidine and clonidine are used for sedation in patients with critical illness receiving mechanical ventilation. Evidence about the cost-effectiveness of intravenous (IV) sedation with these medications is lacking. Objective: To investigate the cost-effectiveness of dexmedetomidine-, clonidine-, and propofol-based IV sedation in patients with critical illness receiving mechanical ventilation. Design, Setting, and Participants: This economic evaluation used within-trial cost-utility analysis with a 6-month time horizon comparing dexmedetomidine-, clonidine-, and propofol-based IV sedation from a UK National Health Service and Personal Social Services perspective, with individual-level data collected from the Alpha 2 Agonists for Sedation to Produce Better Outcomes From Critical Illness (A2B) trial. Adults with critical illness receiving mechanical ventilation, with an anticipated total requirement for mechanical ventilation of at least 2 days, from 41 intensive care units in the UK were included. Recruitment ran from December 2018 through October 2023; the last date of follow-up was December 10, 2023. Interventions: Dexmedetomidine, clonidine, or propofol IV sedation. Patients receiving α2 agonists were permitted to receive supplemental propofol to achieve the target sedation score if required. Main Outcomes and Measures: Incremental costs and quality-adjusted life years (QALYs) gained between dexmedetomidine-based vs propofol-ba...