Economic Impact of Anesthetist-Administered Sedation in Outpatient Gastrointestinal Endoscopy

Abstract

Purpose: Almost all gastrointestinal endoscopic procedures performed with propofol sedation (92%) use an anesthesiologist or a certified registered nurse anesthetist (CRNA) (Cohen 2005) and the economic impact of anesthetist-administered sedation in gastrointestinal endoscopy has not been economically quantified. Methods: A model was developed to quantify the economic impact of anesthetist-administered sedation in patients undergoing outpatient gastrointestinal endoscopic procedures in a hospital outpatient clinic, physician office, and ambulatory surgical center (ASC). The model was created from the perspective of the U.S. healthcare system. Reimbursement inputs for anesthesia professional services were obtained from published literature (Aisenberg 2005). As these rates vary by payer, a weighted average was calculated based on the distribution of payer type for endoscopic procedures (CDC 2001). The number of gastrointestinal endoscopic procedures performed in the U.S. was estimated using NDCHealth, Solucient, and Verispan data. To measure the robustness of model results to changes in base case inputs, sensitivity analyses were performed. Using a Monte Carlo simulation, the inputs were varied simultaneously and randomly for 1,000 iterations to determine a range of cost estimates. Results: The total number of outpatient gastrointestinal endoscopic procedures performed in the U.S. is projected to be between 20.4 and 22.3 million in 2005. Approximately 5.1 to 5.6 million of these gastrointestinal endoscopic procedures are performed with propofol sedation. The anesthetist costs associated with gastrointestinal endoscopic procedures using propofol sedation are projected to range from $1.3 to $1.4 billion in 2005. Sensitivity analyses indicated that estimated annual costs of anesthetist-administered sedation for gastrointestinal endoscopy were most influenced by anesthetist professional fees and the percent of procedures using propofol sedation. Conclusions: Anesthetist-administered sedation for gastrointestinal endoscopy results in a significant economic burden to the U.S. healthcare system. This burden is likely to increase due to population growth, potential increases in colorectal cancer screening compliance, and the increased use of propofol for gastrointestinal endoscopy. As the dynamics of reimbursement change frequently, further research is warranted to determine the entities financially responsible for this burden.