---
title: "Economic evaluations of remifentanil versus fentanyl for analgo‑sedation in mechanically ventilate"
id: "pubmed-42769004"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42769004"
content_type: "clinical_feed_article"
specialty: "Critical Care"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42769004/"
doi: "10.1111/imj.70632"
published_at: "2026-09-22T00:00:00.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Economic evaluations of remifentanil versus fentanyl for analgo‑sedation in mechanically ventilate
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42769004
- **Specialty:** [Critical Care](https://medichelpline.com/clinical-feed/critical-care.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42769004/)
- **DOI:** [10.1111/imj.70632](https://doi.org/10.1111%2Fimj.70632)
- **Published At:** 2026-09-22T00:00:00.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- Systematic review assessed economic evaluations comparing **remifentanil**-based and **fentanyl**-based analgo‑sedation for adults receiving invasive mechanical ventilation (IMV) in the ICU. - Literature search covered Ovid MEDLINE, Ovid Embase and the Cochrane Library for English full‑text studies published from 1997 to 2023. - Of 169 records identified (103 after deduplication), eight full texts were reviewed and only two single‑centre economic evaluations met inclusion criteria, together enrolling 285 patients. - The two included studies used different methodologies, assessed different outcomes, included different cost components, adopted different analytical perspectives and applied dissimilar time horizons. - Reporting quality measured using the 24‑item CHEERS checklist was rated 59% for Muellejans et al. and 81% for Al et al. - Both studies reported shorter durations of **IMV** and **ICU** stay with remifentanil but produced inconsistent economic results: Al et al. suggested remifentanil may reduce costs; Muellejans et al. reported similar total costs across groups, largely because remifentanil acquisition costs were higher. - The review concluded there is limited and heterogeneous evidence on the economic impact of remifentanil in mechanically ventilated ICU patients. - Authors call for high‑quality economic evaluations reflecting contemporary clinical practice, comprehensive cost measurement and appropriate time horizons to determine whether remifentanil provides value for money in intensive care.
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Online ahead of print. # Economic evaluations of remifentanil versus fentanyl for analgo-sedation in mechanically ventilated adult ICU patients: a systematic review [Sushma Ashwin](https://pubmed.ncbi.nlm.nih.gov/?term=Ashwin+S&cauthor_id=42769004)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42769004/#full-view-affiliation-1 "Department of Health Economics, Deakin University, Burwood, Victoria, Australia."), [Lisa Gold](https://pubmed.ncbi.nlm.nih.gov/?term=Gold+L&cauthor_id=42769004)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42769004/#full-view-affiliation-1 "Department of Health Economics, Deakin University, Burwood, Victoria, Australia."), [Arvind Rajamani](https://pubmed.ncbi.nlm.nih.gov/?term=Rajamani+A&cauthor_id=42769004)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42769004/#full-view-affiliation-2 "Nepean Clinical School, University of Sydney, Kingswood, New South Wales, Australia.")[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42769004/#full-view-affiliation-3 "Department of Intensive Care Medicine, Nepean Hospital, Kingswood, New South Wales, Australia."), [Ashwin Subramaniam](https://pubmed.ncbi.nlm.nih.gov/?term=Subramaniam+A&cauthor_id=42769004)[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42769004/#full-view-affiliation-4 "Australian and New Zealand Intensive Care Research Centre \(ANZIC RC\), Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.")[ 5 ](https://pubmed.ncbi.nlm.nih.gov/42769004/#full-view-affiliation-5 "Department of Intensive Care, Dandenong Hospital Monash Health, Dandenong, Victoria, Australia.")[ 6 ](https://pubmed.ncbi.nlm.nih.gov/42769004/#full-view-affiliation-6 "Department of Intensive Care, Epworth Healthcare, Richmond, Victoria, Australia.")[ 7 ](https://pubmed.ncbi.nlm.nih.gov/42769004/#full-view-affiliation-7 "Australian and New Zealand Intensive Care Society, Centre for Outcome and Resource Evaluation, Melbourne, Victoria, Australia.") Affiliations Expand ### Affiliations * 1 Department of Health Economics, Deakin University, Burwood, Victoria, Australia. * 2 Nepean Clinical School, University of Sydney, Kingswood, New South Wales, Australia. * 3 Department of Intensive Care Medicine, Nepean Hospital, Kingswood, New South Wales, Australia. * 4 Australian and New Zealand Intensive Care Research Centre (ANZIC RC), Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia. * 5 Department of Intensive Care, Dandenong Hospital Monash Health, Dandenong, Victoria, Australia. * 6 Department of Intensive Care, Epworth Healthcare, Richmond, Victoria, Australia. * 7 Australian and New Zealand Intensive Care Society, Centre for Outcome and Resource Evaluation, Melbourne, Victoria, Australia. * PMID: **42769004** * DOI: [ 10.1111/imj.70632 ](https://doi.org/10.1111/imj.70632) Item in Clipboard Review # Economic evaluations of remifentanil versus fentanyl for analgo-sedation in mechanically ventilated adult ICU patients: a systematic review Sushma Ashwin et al. Intern Med J. 2026. Show details Display options Display options Format Abstract PubMed PMID Intern Med J Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Intern+Med+J%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22Intern+Med+J%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42769004/) . 2026 Sep 22. doi: 10.1111/imj.70632. Online ahead of print. ### Authors [Sushma Ashwin](https://pubmed.ncbi.nlm.nih.gov/?term=Ashwin+S&cauthor_id=42769004)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42769004/#short-view-affiliation-1 "Department of Health Economics, Deakin University, Burwood, Victoria, Australia."), [Lisa Gold](https://pubmed.ncbi.nlm.nih.gov/?term=Gold+L&cauthor_id=42769004)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42769004/#short-view-affiliation-1 "Department of Health Economics, Deakin University, Burwood, Victoria, Australia."), [Arvind Rajamani](https://pubmed.ncbi.nlm.nih.gov/?term=Rajamani+A&cauthor_id=42769004)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42769004/#short-view-affiliation-2 "Nepean Clinical School, University of Sydney, Kingswood, New South Wales, Australia.")[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42769004/#short-view-affiliation-3 "Department of Intensive Care Medicine, Nepean Hospital, Kingswood, New South Wales, Australia."), [Ashwin Subramaniam](https://pubmed.ncbi.nlm.nih.gov/?term=Subramaniam+A&cauthor_id=42769004)[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42769004/#short-view-affiliation-4 "Australian and New Zealand Intensive Care Research Centre \(ANZIC RC\), Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.")[ 5 ](https://pubmed.ncbi.nlm.nih.gov/42769004/#short-view-affiliation-5 "Department of Intensive Care, Dandenong Hospital Monash Health, Dandenong, Victoria, Australia.")[ 6 ](https://pubmed.ncbi.nlm.nih.gov/42769004/#short-view-affiliation-6 "Department of Intensive Care, Epworth Healthcare, Richmond, Victoria, Australia.")[ 7 ](https://pubmed.ncbi.nlm.nih.gov/42769004/#short-view-affiliation-7 "Australian and New Zealand Intensive Care Society, Centre for Outcome and Resource Evaluation, Melbourne, Victoria, Australia.") ### Affiliations * 1 Department of Health Economics, Deakin University, Burwood, Victoria, Australia. * 2 Nepean Clinical School, University of Sydney, Kingswood, New South Wales, Australia. * 3 Department of Intensive Care Medicine, Nepean Hospital, Kingswood, New South Wales, Australia. * 4 Australian and New Zealand Intensive Care Research Centre (ANZIC RC), Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia. * 5 Department of Intensive Care, Dandenong Hospital Monash Health, Dandenong, Victoria, Australia. * 6 Department of Intensive Care, Epworth Healthcare, Richmond, Victoria, Australia. * 7 Australian and New Zealand Intensive Care Society, Centre for Outcome and Resource Evaluation, Melbourne, Victoria, Australia. * PMID: **42769004** * DOI: [ 10.1111/imj.70632 ](https://doi.org/10.1111/imj.70632) Item in Clipboard Cite Display options Display options Format Abstract PubMed PMID ## 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. **Keywords:** ICU; cost‐effectiveness; economic evaluation; intensive care; opioids; remifentanil. © 2026 The Author(s). Internal Medicine Journal published by John Wiley & Sons Australia, Ltd on behalf of Royal Australasian College of Physicians. [PubMed Disclaimer](https://pubmed.ncbi.nlm.nih.gov/disclaimer/) ## References 1. 1. Hodgson CL, Cooper DJ, Arabi Y, King V, Bersten A, Bihari S et al. Maximal recruitment open lung ventilation in acute respiratory distress syndrome (PHARLAP). A phase II, multicenter randomized controlled clinical trial. Am J Respir Crit Care Med 2019; 200: 1363–1372 (in English). 2. 1. Wunsch H, Kahn JM, Kramer AA, Rubenfeld GD. Use of intravenous infusion sedation among mechanically ventilated patients in the United States. Crit Care Med 2009; 37: 3031–3039 (in English). 3. 1. Casamento A, Bellomo R. Fentanyl versus morphine for analgo‐sedation in mechanically ventilated adult ICU patients. Crit Care Resusc 2019; 21: 76–83 (in English). 4. 1. Murray MJ, Oyen LJ, and Browne WT. Use of sedatives, analgesics, and neuromuscular blockers. In: Parrillo LDR, ed. Critical Care Medicine ‐ Principles of Diagnosis and Management in the Adult, 3rd edn. Philadelphia: ELSEVIER; 2008; 327–342. 5. 1. Egan TD. Remifentanil pharmacokinetics and pharmacodynamics. A preliminary appraisal. Clin Pharmacokinet 1995; 29: 80–94 (in English). 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