Cost-Minimisation Analysis of Midazolam versus Droperidol for Acute Agitation in the Emergency Department

Authors

  • Esther W Chan BPharm (Hons), MClinPharm,

    PhD Candidate, Assistant Professor
    1. Centre for Medicine Use and Safety, Department of Pharmacology and Pharmacy, Monash University, University of Hong Kong
    Search for more papers by this author
  • Jonathan C Knott MBBS, PhD, FACEM,

    Staff Specialist, Deputy Director
    1. Emergency Department, The Royal Melbourne Hospital
    Search for more papers by this author
  • Danny Liew MBBS, FRACP, PhD,

    Director
    1. Centre for Clinical Epidemiology, Biostatistics and Health Services Research, The University of Melbourne, The Royal Melbourne Hospital
    Search for more papers by this author
  • David McD Taylor MD, MPH, DRCOG, FACEM,

    Director of Emergency and General Medicine Research
    1. Austin Health
    Search for more papers by this author
  • David CM Kong GCHE, BPharm, MPharm, PhD

    Lecturer, Corresponding author
    1. Centre for Medicine Use and Safety, Monash University, Parkville, Victoria
    • Address for correspondence: Dr David Kong, Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville Vic. 3052, Australia. E-mail: David.Kong@monash.edu

    Search for more papers by this author

ABSTRACT

Aim

To compare the costs of midazolam and droperidol for the management of acute agitation in the emergency department (ED).

Method

A decision analysis model was used to undertake a cost-minimisation analysis of resource utilisation in the ED of a Melbourne hospital. Data from acutely agitated patients who received midazolam (n = 74) or droperidol (n = 79) in a randomised clinical trial (February 2002 to April 2004) were reviewed.

Results

All direct medical and non-medical costs relating to the management of acute agitation in the ED were analysed. The average cost scenario was estimated for the 2 treatments. The model simulated 9 possible outcomes based on whether patients were ‘sedated’ or ‘not sedated’ and whether they required ‘re-dosing’ or ‘no re-dosing’. Hospitalisation cost incorporated multiple items as part of the average cost per service code for the ED length of stay. In the base case analysis, midazolam was associated with notably less overall drug costs (A$3.05 vs A$21.10), which contributed to less total treatment costs. The ‘expected’ median ED length of stay was marginally longer in the midazolam group (12 vs 11.8 hours), resulting in slightly higher hospitalisation costs (A$1370 vs A$1361). The midazolam group incurred higher median costs for pathology (A$78.60 vs A$61.60) and imaging (A$5.25 vs A$0.60). The cost of electrocardiograms was similar (A$27.10 vs A$28). With a cost advantage of A$59 per patient, midazolam was 3.8% less costly than droperidol (A$1496 vs A$1555).

Conclusion

Midazolam was marginally more cost saving than droperidol when used to manage acute agitation in the ED. Several challenges were identified that need to be overcome to enable future robust pharmacoeconomic studies.

Ancillary