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Title: Economic Evaluation of Midazolam-Droperidol Combination, Versus Droperidol or Olanzapine for the Management of Acute Agitation in the Emergency Department: A Within-Trial Analysis.
Austin Authors: Yap, Celene Y L;Hsueh, Ya-Seng Arthur;Knott, Jonathan C;Taylor, David McD ;Chan, Esther W;Kong, David C M
Affiliation: Centre for Medicine Use and Safety, Monash University, 381 Royal Parade, Parkville, VIC, 3052, Australia
Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie Street, Carlton, VIC, 3053, Australia
Emergency Department, Royal Melbourne Hospital, Grattan Street, Parkville, VIC, 3052, Australia
Department of Emergency Medicine, Austin Health, Heidelberg, Victoria, Australia
Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 2/F Laboratory Block, 21 Sassoon Road, Pokfulam, Hong Kong
Pharmacy Department, Ballarat Health Services, 1 Drummond St N, Ballarat, VIC, 3350, Australia
Issue Date: 24-Jul-2017 2017
Publication information: PharmacoEconomics - open 2017; online first: 24 July
Abstract: The combination of midazolam and droperidol has proven superior to droperidol or olanzapine monotherapy in the management of acute agitation in emergency departments (EDs). This is the first economic analysis to evaluate the cost-benefit and cost effectiveness of the midazolam-droperidol combination compared with droperidol or olanzapine for the management of acute agitation in EDs. This analysis used data derived from a randomised, controlled, double-blind clinical trial conducted in two metropolitan Australian EDs between October 2014 and August 2015. The economic evaluation was from the perspective of Australian public hospital EDs. The main outcomes included agitation management time and the agitation-free time gained. Sensitivity analyses were undertaken. The midazolam-droperidol combination was the least costly regimen (Australian dollars [AU$]46.25 per patient) compared with the droperidol and olanzapine groups (AU$92.18 and AU$110.45 per patient, respectively). The main cost driver for all groups was the cost of the labour required during the initial adequate sedation. The combination afforded an additional 10-13┬ámin of mean agitation-free time gained, which can be translated to additional savings of AU$31.24-42.60 per patient compared with the droperidol and olanzapine groups. The benefit-cost ratio for the midazolam-droperidol combination was 12.2:1.0, or AU$122,000 in total benefit for every AU$10,000 spent on management of acute agitation. Sensitivity analyses over key variables indicated these results were robust. The midazolam-droperidol combination may be a cost-saving and dominant cost-effective regimen for the treatment of acute agitation in EDs as it is more effective and less costly than either droperidol or olanzapine monotherapy.
DOI: 10.1007/s41669-017-0047-y
ORCID: 0000-0002-8986-9997
PubMed URL: 29623620
Type: Journal Article
Appears in Collections:Journal articles

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