A Preliminary Cost/Efficacy Analysis of MIRUS System for Sedation of Critical Patients

Side effects of traditional analgo-sedative agents call the attention to alternative strategies of sedation for critically ill patients; volatile anaesthetics (VAs) are considered potential substitutes in selected categories of patients. MIRUSTM (Pall Corporation and TIM Germany) is an innovative system for the administration of VAs to these patients admitted in intensive care unit (ICU). The aim of this study was to analyse the clinical and economical characteris- tics of MIRUSTM, following the Health Technology Assessment principles (HTA); in particular, the study was focused on defining a cost/efficacy ratio of the use of MIRUSTM in an ICU with 8 beds and 80 procedures/year. HTA allows predicting the system impact in the clinical pathway before material introduction. The assessment showed that MIRUSTM could be innovative, safe and efficient, especially when applied to critically ill patients with compromised organ func- tion. For the purposes of assessment, three classes of ICU treatments have been defined: short- (6-24 hours), medium- (24-96 hours) and long-term (>96 hours) sedation (SS, MS, LS). Based on the technical characteristics of system, MIRUSTM could be considered unfit for LS. Considering clinical characteristics, effects on patients, sedation times and costs, the HTA shows how the procedure costs are different for each class. In conclusion, the use of MIRUSTM could be useful and effective for critically ill patients, in which standard sedation may be associated with drug hangover. This assessment seems economically advantageous for SS, where cost/efficacy ratios are positive performing 400 procedures/year, while for MS the cost of drugs impacts on the procedure cost. Therefore, looking at the potential clinical benefits on all potential treatable patients, the best addition strategy of the system in the hospital should be evaluated to optimize the cost/efficacy ratio.