{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T12:56:23Z","timestamp":1791377783955,"version":"4.3.2"},"reference-count":27,"publisher":"American Medical Association (AMA)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"Importance<\/jats:title>Propofol and the \u03b12<\/jats:sub> 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.<\/jats:p><\/jats:sec>Objective<\/jats:title>To investigate the cost-effectiveness of dexmedetomidine-, clonidine-, and propofol-based IV sedation in patients with critical illness receiving mechanical ventilation.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>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.<\/jats:p><\/jats:sec>Interventions<\/jats:title>Dexmedetomidine, clonidine, or propofol IV sedation. Patients receiving \u03b12<\/jats:sub> agonists were permitted to receive supplemental propofol to achieve the target sedation score if required.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>Incremental costs and quality-adjusted life years (QALYs) gained between dexmedetomidine-based vs propofol-based and clonidine-based vs propofol-based IV sedation were assessed. Mean net monetary benefits with each medication were assessed.<\/jats:p><\/jats:sec>Results<\/jats:title>Among 1404 adults with critical illness receiving mechanical ventilation (mean [SD] age, 59.2 [14.9] years; 901 male [64.2%]), the mean (SD) Acute Physiology and Chronic Health Evaluation (APACHE) II score was 20.3 (8.2). The incremental cost for dexmedetomidine vs propofol was $1273 (95% CI, \u2212$5000 to $7545), and for clonidine vs propofol, it was \u2212$1328 (\u2212$7114 to $4459). For dexmedetomidine vs propofol, there were 0.0008 QALYs (95% CI, \u22120.0198 to 0.0214 QALYs) gained, and for clonidine vs propofol, there were \u22120.0019 QALYs (95% CI, \u22120.0221 to 0.0181 QALYs) gained. Mean net monetary benefits for dexmedetomidine, clonidine, and propofol were \u2212$53\u202f278 (95% CI, \u2212$58\u202f063 to \u2212$48\u202f493), \u2212$50\u202f882 (95% CI, \u2212$55\u202f003 to \u2212$46\u202f762), and \u2212$52\u202f036 (95% CI, \u2212$56\u202f230 to \u2212$47\u202f834), respectively, at a maximum willingness to pay for a QALY of $16\u202f250.<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>In this study, dexmedetomidine-, clonidine-, and propofol-based IV sedation in patients with critical illness receiving mechanical ventilation had similar costs and QALYs. These findings suggest that economic considerations should not affect which sedative these patients receive.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2025.17533","type":"journal-article","created":{"date-parts":[[2025,5,19]],"date-time":"2025-05-19T22:30:32Z","timestamp":1747693832000},"page":"e2517533","source":"Crossref","is-referenced-by-count":5,"title":["Cost-Effectiveness of \u03b12<\/sub> Agonists for Intravenous Sedation in Patients With Critical Illness"],"prefix":"10.1001","volume":"8","author":[{"given":"Stephen","family":"Morris","sequence":"first","affiliation":[{"name":"Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nazir I.","family":"Lone","sequence":"additional","affiliation":[{"name":"Usher Institute, The University of Edinburgh, Edinburgh, United 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