Internal Medicine Journal· 2026Q2· Review
Economic evaluations of remifentanil versus fentanyl for analgo‐sedation in mechanically ventilated adult ICU patients: a systematic review
- 0citations
- Q2SCImago
- 2026year
Short summary
A systematic review of two studies (285 patients) found limited and inconsistent economic evidence comparing remifentanil to fentanyl for sedating mechanically ventilated ICU patients, with one study suggesting cost reduction and the other showing similar total costs due to remifentanil's higher acquisition price.
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Key points
- Only two studies met inclusion criteria for economic evaluation of remifentanil vs. fentanyl in ventilated ICU patients, involving 285 patients.
- Both included studies reported shorter durations of mechanical ventilation and ICU stay with remifentanil.
- Economic findings were inconsistent: one study suggested cost reduction with remifentanil, while the other found similar total costs.
- Remifentanil's higher acquisition cost was a key factor in the inconsistent economic outcomes.
AI-generated from the title and abstract; the full text is not read.
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.
The authors' abstract, as published at the source. Internal Medicine Journal, 2026 · DOI ↗
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Field: Critical Care and Intensive Care Medicine
Critical Care and Intensive Care MedicineMedicine