Economic evaluations of remifentanil versus fentanyl for analgo-sedation in mechanically ventilated adult ICU patients: a systematic review

Abstract

The use of opioid and sedative infusions to relieve pain and anxiety is common among patients receiving invasive mechanical ventilation (IMV) in the intensive care unit (ICU). Although remifentanil-based sedation is feasible, evidence regarding its economic impact remains limited. We systematically identified, synthesised and critically appraised economic evaluations of remifentanil in mechanically ventilated ICU patients. Ovid MEDLINE, Ovid Embase and the Cochrane Library were searched for full-text original English-language studies published between 1997 and 2023. Reporting quality was assessed using the 24-item Consolidated Health Economic Evaluation Reporting Standards checklist. Of 169 records identified, 103 remained after duplicate removal, eight underwent full-text review and only two single-centre studies, involving 285 patients, met the inclusion criteria. The studies differed substantially in their methodology, including the outcomes assessed, cost components, analytical perspectives and time horizons. Reporting quality was rated as good (59%) in the study by Muellejans et al. and very good (81%) in the study by Al et al. Both studies reported shorter durations of IMV and ICU stay with remifentanil; however, their economic findings were inconsistent. Al et al. reported that remifentanil may reduce costs, whereas Muellejans et al. found similar total costs between treatment groups, largely because of the higher acquisition cost of remifentanil. This systematic review identified limited and heterogeneous evidence regarding the economic impact of remifentanil in mechanically ventilated ICU patients. Given the substantial costs of intensive care, high-quality economic evaluations using contemporary clinical practice, comprehensive cost measurement and appropriate time horizons are needed to determine whether remifentanil provides value for money.