Patient‐controlled sedation with propofol for endoscopic procedures—A cost analysis

Abstract

Background: Patient-controlled sedation (PCS) with propofol accompanied by a bedside nurse anaesthetist is an alternative sedation method for endoscopic procedures compared with midazolam administered by a nurse or endoscopist. Increasing costs in health care demands an economic perspective when introducing alternative methods. We applied a hospital perspective on a cost analysis comparing different methods of sedation and the resource use that were expected to affect cost differences related to the sedation.Methods: Based on two randomised previous studies, the direct costs were determined for different sedation methods during two advanced endoscopic procedures: endoscopic retrograde cholangiopancreatography (ERCP) and flexible bronchoscopy including endobronchial ultrasound. ERCP comparisons were made between midazolam sedation by the endoscopic team, PCS with a bedside nurse anaesthetist and propofol sedation administered by a nurse anaesthetist. Bronchoscopy comparisons were made between midazolam sedation by the endoscopic team and PCS with a bedside nurse anaesthetist, categorised by premedication morphine-scopolamine or glycopyrronium.Results: Propofol PCS with a bedside nurse anaesthetist resulted in lower costs per patient for sedation for both ERCP (233 USD) and bronchoscopy (premedication morphine-scopolamine 267 USD, premedication glycopyrronium 269 USD) compared with midazolam (ERCP 425 USD, bronchoscopy 337 USD). Aborted procedures that needed to be repeated and prolonged hospital stays significantly increased the cost for the midazolam groups. Conclusion:Propofol PCS with a bedside nurse anaesthetist reduces the direct sedation costs for ERCP and bronchoscopy procedures compared with midazolam sedation.

Patient-Controlled Sedation by Non-Anaesthesiologists During Flexible Bronchoscopy – A One-Year Experience Regarding Safety, Feasibility and Costs

“…The transition from midazolam has reduced costs for sedation, even with the presence or consultation of anaesthetic staff [9]. By replacing anaesthetic staff with and additional nurse as team member the costs for sedation are reduced.…”

“…The method is considered safe within the field of endoscopy in terms of its low risk for cardiorespiratory adverse events, oversedation and rescue interventions [1,2]. The use of propofol instead of midazolam increases patient tolerance, improves recovery and reduces costs for sedation without affecting the procedure feasibility [3][4][5][6][7][8][9].…”

“…By shifting tasks of providers and their scope of practice, scarce resources of anesthesia can be used more efficiently, and health care costs reduced without compromising safety, feasibility, and satisfaction [14]. Two studies have investigated PCS during bronchoscopy, both involving the presence of a nurse anaesthetist and one using propofol [9]. The study using propofol resulted in an educational and training program for the staff at the department during 2019 regarding NAPS using the PCS device for propofol administration.…”

Response Letter to the editor

“…BG, LN, LB, AN, and FS contributed substantially to the study design, cost analysis and interpretation, and writing of the manuscript. Benjamin Grossmann 1,2 Andreas Nilsson 2,3 Folke Sjöberg 1,4 Lars Bernfort 5 Lena Nilsson 2,3 1…”

Patient-Controlled Sedation in Port Implantation (PACSPI 1) – a Feasibility Trial

“…Clinician-controlled sedation (CCS) involves administration of procedural analgosedation by a trained clinician. However, it carries the risk of oversedation and generates higher costs compared to alternative sedation methods [3,4]. Patient-controlled sedation (PCS) is an alternative sedation method to CCS, enabling patients to self-administer and self-regulate their sedation and analgesia during the procedure.…”