Desirable Effects How substantial are the desirable anticipated effects? ● Trivial No research evidence was identified. Effects How substantial are the undesirable anticipated effects? ● Trivial Certainty of evidence What is the overall certainty of the evidence of effects? ● Low No research evidence was identified. Values Is there important uncertainty about or variability in how much people value the main outcomes? ● Possibly important uncertainty or variability No research evidence was identified. Balance of effects Does the balance between desirable and undesirable effects favor the intervention or the comparison? ● Probably favors the intervention No research evidence was identified. Undesirabl
Resources required How large are the resource requirements (costs)? ○ costs ○ Moderate costs ● Negligible costs and savings ○ Moderate savings ○ Large savings ○ Varies ○ Don't know No research evidence was identified. Certainty of evidence of required resources What is the certainty of the evidence of resource requirements (costs)? ○ Very low ○ Low ○ Moderate ○ High ○ No included studies No research evidence was identified. Cost effect- iveness Does the cost-effectiveness of the intervention favor the intervention or the comparison ● No included studies No research evidence was identified.
or variability uncertainty or variability Balance of effects Favors the Probably favors the comparison Does not either the intervention or the comparison Probably favors the intervention Favors the intervention Varies Don't know Resources required Large costs Moderate costs Negligible and savings Moderate savings Large savings Varies Don't know Certainty of evidence of required resources Very low Low Moderate High No included studies Cost effectiveness Favors the Probably favors the comparison Does not favor either the intervention or the comparison Probably favors the intervention Favors the intervention Varies No included studies Equity Reduced Probably reduced Probably no impact Probably increased Increased Varies Don't know Acceptability No Probably no Probably yes Yes Varies Don't know Feasibility No Probably no Probably yes Yes Varies Don't know
effect size on outcomes was moderate and the medications per say are off patent now Certainty of evidence of required resources What is the certainty of the evidence of resource requirements (costs)? ● No included studies Cost effect- iveness Does the cost-effectiveness of the intervention favor the intervention or the comparison? ● Does not favor either the intervention or the comparison See above on cost Accept- ability Is the intervention acceptable to key stakeholders? ● Yes Feasibility Is the intervention feasible to implement? ● Yes Summary of judgements Judgement
Problem No Probably no Probably yes Yes Varies Don't know Desirable Effects Trivial Small Moderate Large Varies Don't know Undesirable Effects Large Moderate Small Trivial Varies Don't know Certainty of evidence Very low Low Moderate High No included studies Values Important uncertainty or variability Possibly important uncertainty or variability Probably no important uncertainty or variability No important uncertainty or variability No undesirable outcomes Balance of effects Favors the comparison Probably favors the comparison Does not favor either the intervention or the comparison Probably favors the intervention Favors the intervention Varies Don't know Resources required Large costs Moderate costs Negligible costs and savings Moderate savings Large savings Varies Don't know Certainty of evidence of required resources Very low Low Moderate High No included studies Cost effectiveness Favors the comparison Probably favors the comparison Does not favor either the intervention or the comparison Probably favors the intervention Favors the intervention Varies No included studies Equity Reduced Probably reduced Probably no impact Probably increased Increased Varies Don't know Acceptability No Probably no Probably yes Yes Varies Don't know Feasibility No Probably no Probably yes Yes Varies Don't know Conclusions
Certainty of evidence What is the overall certainty of the evidence of effects? ● Low No research evidence was identified. Values Is important uncertainty about or variability in how much people value the main outcomes? ● Probably no important uncertainty or variability No research evidence was identified. Balance of effects Does the balance between desirable and undesirable effects favor the intervention or the comparison? ● Probably favors the intervention No research evidence was identified. Resources required How are the resource requirements (costs)? ● Negligible and savings older studies showed that propofol was more costly, but these data do not apply now, and The moderate effect on outcomes precludes any effects on costs especially now that propofol is off patent.
Certainty of evidence of required resources What is the certainty of the evidence of resource requirements (costs)? ● No included studies No research evidence was identified. Cost effectiveness Does the cost-effectiveness of the intervention favor the intervention or the comparison? ● Does not favor either the intervention or the comparison No research evidence was identified. Acceptability Is the intervention acceptable to key stakeholders? ● Yes No research evidence was identified. Feasibility Is the intervention feasible to implement? ● Yes No research evidence was identified.
Summary of judgements Judgement Problem No Probably no Probably yes Yes Varies Don't know Desirable Effects Trivial Moderate Varies Don't know Undesirable Effects Large Moderate Trivial Varies Don't know Certainty of evidence Very low Low Moderate High No included studies Values Important uncertainty or variability Possibly important uncertainty or variability Probably no important uncertainty or variability No important uncertainty or variability Balance of effects Favors the comparison Probably favors the comparison Does not either the intervention or the comparison Probably favors the intervention Favors the intervention Varies Don't know Resources required Large costs Moderate Negligible costs and savings Moderate savings Large savings Varies Don't know Certainty of evidence of required resources Very low Low Moderate High No included studies Cost effectiveness Favors the comparison Probably favors the comparison Does not favor either the intervention or the comparison Probably favors the intervention Favors the intervention Varies No included studies Equity Reduced Probably reduced Probably no impact Probably increased Increased Varies Don't know Acceptability No Probably no Probably yes Yes Varies Don't know Feasibility No Probably no Probably yes Yes Varies Don't know Conclusions Should propofol vs. a benzodiazepine be used in critically ill ventilated adults (both intubated and non-intubated)?
Resources required How large are the resource requirements (costs)? ○ Large costs ○ Moderate costs ○ Negligible costs and savings ○ Moderate savings ○ Large savings ○ Varies ○ Don't know 1. Can J Hosp Pharm 2012;65(2):103–110. [4] The average cost of the medication DEX Vs. midazolam ($1929.57 Vs. $180.10 per patient). Average costs associated with mechanical ventilation ($2939 Vs. $4448) and management of delirium ($2127 Vs. $3012). The overall cost per patient was ($7022 V. $7680). Cost effectiveness favors alpha2 agonists (dex) but costs are varied since off patent but still many countries have different costs for dex which makes this challenging Certainty of evidence of required resources What is the certainty of the evidence of resource requirements (costs)? x Low Cost effectiveness Does the cost-effectiveness of the intervention favor the intervention or the comparison? ● Probably favors the intervention
Acceptability Is the intervention acceptable to key stakeholders? ● Probably yes Feasibility Is the intervention feasible to implement? ● Yes Summary of judgements Judgement Problem No Probably no Probably yes Yes Varies Don't know Desirable Effects Trivial Small Moderate Large Varies Don't know
Desirable Effects How substantial are the desirable anticipated effects? ● Small There was a consistent message with about a day shorter on mechanical ventilation but no difference in most other outcomes. Similar to the alpha2 vs benzo comparisons the Jakob PRODEX [6] study's eval of delirium was considered difficult to interpret because of its distant measurement. With regards to ICU LOS wide CI. So really only difference was small diff in MV e Effects How substantial are the undesirable anticipated effects? ● Trivial Bradycardia was not different and the hypotension was not diffferent so no real undersirable effect differences Certainty of evidence What is the overall certainty of the evidence of effects? ● Low Values Is there important uncertainty about or variability in how much people value the main outcomes? ● Probably no important uncertainty or With a small difference in MV and no difference in undersiable effects effects the patient rep felt most would not have any uncertainty on what they would prefer Balance of effects Does the balance between desirable and undesirable effects favor the intervention or the comparison? ● Probably favors the intervention
Resources required How are the resource requirements (costs)? ● Don't know no cost data comparing propofol and dex Certainty of evidence of required resources What is the certainty of the evidence of resource requirements (costs)? ● No included studies Cost effecti- veness Does the cost-effectiveness of the intervention favor the intervention or the comparison? ● No included studies Accept -ability Is the intervention acceptable to key stakeholders? ● Probably yes Feasibility Is the intervention feasible to implement? ● Yes Summary of judgements