José María Riesco-López1, Juana Rizo-Pascual2, A Díaz-Sánchez3, Rebeca Manzano-Fernández3, Carlos Martín-Saborido4, David Varillas-Delgado5, Miguel Rivero-Fernández3, Rosario González-Alonso6, Eloísa Moya-Valverde3, Pedro García-Fernández7, Rocío Campos-Cantero3. 1. Department of Gastroenterology, Clínica Universidad de Navarra. 2. Department of Pediatrics, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes. 3. Department of Gastroenterology, Hospital Universitario del Sureste, Arganda del Rey. 4. Department of Research and Postgraduate Studies, Fundación San Juan de Dios, University Health Sciences Centre San Rafael, Universidad Antonio de Nebrija. 5. Research Unit, Universidad Francisco de Vitoria, Faculty of Medicine. 6. Department of Gastroenterology and Hepatology, Hospital Ramón y Cajal. 7. Department of Structural Mechanics and Industrial Constructions, Higher Technical School of Industrial Engineers, Universidad Politécnica de Madrid, Madrid, Spain.
Abstract
OBJECTIVE: Endoscopist-directed propofol (EDP) sedation is becoming more popular, with a reported safety and efficacy similar to anesthesiologist-administered propofol (AAP). The aim of this study is to compare the efficiency of EDP and AAP in patients of low-intermediate anesthetic risk. METHODS: A prospective cost-effectiveness comparison study was conducted. The costs of the endoscopic procedures in the EDP and AAP group were calculated using the full cost methodology after breaking down the endoscopic activity into relative value units to allocate costs in an equitable way. To determine the effectiveness, adverse events related to endoscopic sedation and the number of incomplete procedures were registered for the EDP group and compared with those published by anesthesiologists for AAP. RESULTS: A total of 1165 and 18 919 endoscopic procedures were, respectively, included in the EDP and AAP groups. The average costs of EDP vs. AAP for gastroscopy, colonoscopy and endoscopic ultrasound were &OV0556; 182.81 vs. &OV0556; 332.93, &OV0556; 297.07 vs. &OV0556; 459.76, and &OV0556; 319.92 vs. &OV0556; 485.12, respectively. No significant differences were detected regarding the rate of overall adverse events (4.43 vs. 4.46%) or serious adverse events (0 vs. 0.17%); the rate of arterial hypotension was significantly lower in the EDP group: 0.34 vs. 1.78% [odds ratio (OR), 0.19; 95% confidence interval (CI), 0.08-0.46] and the desaturation rate was significantly lower in the AAP group: 3.26 vs. 1.29% (OR, 2.58; 95% CI, 1.85-3.60). No significant differences were found in terms of incomplete examinations (0.17 vs. 0.14%). CONCLUSION: In patients with low-intermediate anesthetic risk referred for an endoscopic examination, EDP appears to be more efficient than AAP.
OBJECTIVE: Endoscopist-directed propofol (EDP) sedation is becoming more popular, with a reported safety and efficacy similar to anesthesiologist-administered propofol (AAP). The aim of this study is to compare the efficiency of EDP and AAP in patients of low-intermediate anesthetic risk. METHODS: A prospective cost-effectiveness comparison study was conducted. The costs of the endoscopic procedures in the EDP and AAP group were calculated using the full cost methodology after breaking down the endoscopic activity into relative value units to allocate costs in an equitable way. To determine the effectiveness, adverse events related to endoscopic sedation and the number of incomplete procedures were registered for the EDP group and compared with those published by anesthesiologists for AAP. RESULTS: A total of 1165 and 18 919 endoscopic procedures were, respectively, included in the EDP and AAP groups. The average costs of EDP vs. AAP for gastroscopy, colonoscopy and endoscopic ultrasound were &OV0556; 182.81 vs. &OV0556; 332.93, &OV0556; 297.07 vs. &OV0556; 459.76, and &OV0556; 319.92 vs. &OV0556; 485.12, respectively. No significant differences were detected regarding the rate of overall adverse events (4.43 vs. 4.46%) or serious adverse events (0 vs. 0.17%); the rate of arterial hypotension was significantly lower in the EDP group: 0.34 vs. 1.78% [odds ratio (OR), 0.19; 95% confidence interval (CI), 0.08-0.46] and the desaturation rate was significantly lower in the AAP group: 3.26 vs. 1.29% (OR, 2.58; 95% CI, 1.85-3.60). No significant differences were found in terms of incomplete examinations (0.17 vs. 0.14%). CONCLUSION: In patients with low-intermediate anesthetic risk referred for an endoscopic examination, EDP appears to be more efficient than AAP.
Authors: Yoo Min Lee; Ben Kang; Yu Bin Kim; Hyun Jin Kim; Kyung Jae Lee; Yoon Lee; So Yoon Choi; Eun Hye Lee; Dae Yong Yi; Hyo Jeong Jang; You Jin Choi; Suk Jin Hong; Ju Young Kim; Yunkoo Kang; Soon Chul Kim Journal: J Korean Med Sci Date: 2021-05-24 Impact factor: 2.153