Cost-Benefit Analysis of a Pediatric ICU Sedation Weaning Protocol.

Q2 Medicine
Chiara Velez, Jessica J Anderson, J Jackson Resser, Dandan Liu, Kristina A Betters
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引用次数: 0

Abstract

Objective: A risk stratified sedation weaning protocol improved patient outcomes in a pediatric intensive care unit (PICU). We sought to determine the protocol effect on medication costs.

Methods: This was a retrospective observational cohort study in an academic tertiary care children's hospital PICU (2018-2020) comparing the cost when weaning benzodiazepine, alpha agonist, and/or opioid infusions in intubated children <18 years of age.

Results: There were 84 total sedation weaning instances (pre-protocol n = 41 and post-protocol n = 41); 2 patients had 2 encounters, 1 in each phase. The total cost (in 2022 United States Dollars) of sedation weaning was $400,328.87 ($15,994.44/kg) pre-protocol compared with $170,458.85 ($11,227.52/kg) post-protocol. The median cost of sedation wean per patient for pre-protocol patients was $3197.42 (IQR: $322.66-$12,643.29) and post-protocol patients was $1851.44 (IQR: $425.05-$5355.85; p = 0.275). A linear regression model estimated the expected cost of sedation wean for post-protocol patients to be $5173.20 lower than for pre-protocol patients of the same weight and overall drug risk (p = 0.036). The proportion of withdrawal symptoms in the pre-protocol patients (16%) was not significantly different from the proportion in the post-protocol patients (14%; p = 0.435).

Conclusions: Implementation of a PICU sedation weaning protocol in a single-center conferred cost benefit without negatively impacting patient outcomes. A larger multicenter study would provide insight to the applicability to PICUs in varied settings with differing patient populations.

儿科重症监护室镇静剂断药方案的成本效益分析。
目的:儿科重症监护病房(PICU)的风险分层镇静断药方案改善了患者的预后。我们试图确定该方案对用药成本的影响:这是一项回顾性观察队列研究,在一家学术性三甲儿童医院的 PICU 中进行(2018-2020 年),比较插管儿童在断开苯二氮卓、α-激动剂和/或阿片类药物输注时的成本:共有 84 例镇静剂断药(协议前 n = 41 例,协议后 n = 41 例);2 名患者有 2 次机会,每个阶段 1 次。协议前镇静断奶的总费用(2022 年美元)为 400,328.87 美元(15,994.44 美元/公斤),协议后为 170,458.85 美元(11,227.52 美元/公斤)。协议前患者每位患者的镇静剂断药成本中位数为 3197.42 美元(IQR:322.66-12643.29 美元),协议后患者为 1851.44 美元(IQR:425.05-5355.85 美元;P = 0.275)。根据线性回归模型估算,在相同体重和总体用药风险的情况下,协议后患者的镇静剂断药预期成本比协议前患者低 5173.20 美元(p = 0.036)。协议前患者出现戒断症状的比例(16%)与协议后患者出现戒断症状的比例(14%;p = 0.435)没有显著差异:在单个中心实施 PICU 镇静剂断药方案可带来成本效益,但不会对患者预后产生负面影响。更大规模的多中心研究将有助于深入了解该方案是否适用于病人群体不同、环境各异的 PICU。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Journal of Pediatric Pharmacology and Therapeutics
Journal of Pediatric Pharmacology and Therapeutics Medicine-Pediatrics, Perinatology and Child Health
CiteScore
2.40
自引率
0.00%
发文量
90
期刊介绍: The Journal of Pediatric Pharmacology and Therapeutics is the official journal of the Pediatric Pharmacy Advocacy Group. JPPT is a peer-reviewed multi disciplinary journal that is devoted to promoting the safe and effective use of medications in infants and children. To this end, the journal publishes practical information for all practitioners who provide care to pediatric patients. Each issue includes review articles, original clinical investigations, case reports, editorials, and other information relevant to pediatric medication therapy. The Journal focuses all work on issues related to the practice of pediatric pharmacology and therapeutics. The scope of content includes pharmacotherapy, extemporaneous compounding, dosing, methods of medication administration, medication error prevention, and legislative issues. The Journal will contain original research, review articles, short subjects, case reports, clinical investigations, editorials, and news from such organizations as the Pediatric Pharmacy Advocacy Group, the FDA, the American Academy of Pediatrics, the American Society of Health-System Pharmacists, and so on.
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