A simple endoscopic pancreatic function test with synthetic porcine secretin appears to distinguish patients with known chronic pancreatitis from those with chronic abdominal pain without chronic pancreatitis. This simple, practical endoscopic test can be performed during upper endoscopy and may decrease the need for invasive procedures in patients with abdominal pain and normal radiographic imaging studies.
OBJECTIVES: Meperidine/midazolam (M/M) and propofol (P) are clinically effective alternatives for sedation during endoscopic procedures. Propofol has a higher acquisition cost, but may be associated with cost savings due to shorter duration of post‐procedure care. The objective of this project was to compare the costs associated with complex upper endoscopic procedures (ERCP/EUS) in subjects who received either M/M or propofol. METHODS: Subjects scheduled for ERCP/EUS were randomized to receive M/M or P during the procedure. A blinded observer assessed time to recovery using a standard 10‐point postanesthesia recovery score (PARS) every 15 minutes. Once a PARS score of 10 was reached, the study terminated and the subject was discharged from the recovery ward. The cost of drug (source: Redbook), an anesthetist for the propofol group (source: Bureau of Labor Statistics), recovery room personnel costs (source: Bureau of Labor Statistics), and overhead costs were compared from the institutional perspective. A sensitivity analysis was performed by assuming generic drug, a nurse anesthetist, and licensed practical nurse (LPN) care in the recovery ward. RESULTS: 33 and 31 subjects were randomized to receive M/M and P, respectively. There were no significant differences detected between the groups in age, gender, case severity, or procedure duration. P group subjects had a significantly shorter post‐procedure recovery time (19 minutes) compared with M/M group subjects (71 minutes, p < 0.001). Subjects in the M/M group cost an average of $65 per case, while P group subjects cost an average of $144 per case (p < 0.001). The sensitivity analysis resulted in an average cost of $77 per case in the P group and $34 in the M/M group (p < 0.001). CONCLUSIONS: Subjects in the P group had a significantly shorter post‐procedure recovery time but this did not result in cost savings compared with subjects treated with M/M.
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