Patient-controlled sedation with propofol for endoscopic procedures-A cost analysis

Area of Science:

• Medical Economics
• Anesthesiology
• Gastroenterology

Background:

• Healthcare costs necessitate economic evaluations of alternative sedation methods.
• Patient-controlled sedation (PCS) with propofol offers an alternative to traditional midazolam sedation for endoscopic procedures.
• A hospital perspective was adopted for cost analysis comparing sedation resource utilization.

Purpose of the Study:

• To compare the direct costs of propofol-based PCS versus midazolam sedation for advanced endoscopic procedures.
• To evaluate the economic impact of different sedation strategies on healthcare resource use.

Main Methods:

• A cost analysis was performed based on two randomized controlled trials.
• Direct costs were determined for endoscopic retrograde cholangiopancreatography (ERCP) and flexible bronchoscopy.
• Sedation methods compared included midazolam by the endoscopic team, propofol PCS with a nurse anesthetist, and propofol sedation by a nurse anesthetist.

Main Results:

• Propofol PCS with a nurse anesthetist was significantly cheaper per patient than midazolam for both ERCP and bronchoscopy.
• Sedation costs for ERCP were $233 USD for propofol PCS versus $425 USD for midazolam.
• Sedation costs for bronchoscopy were $267-$269 USD for propofol PCS versus $337 USD for midazolam.
• Midazolam sedation led to higher costs due to aborted procedures and prolonged hospital stays.

Conclusions:

• Propofol PCS administered by a nurse anesthetist reduces direct sedation costs for ERCP and bronchoscopy.
• This sedation method presents a more economical alternative to midazolam for these procedures.