More Using Sedation for Colonoscopy and Endoscopy

RAND Corporation researchers with the financial support of Ethicon Endo-Surgery (EES) conducted a study of data from claims of 1.1 million Medicare recipients and 5.5 million patients who have private medical insurance. The study was geared towards finding a trend in the use of nurse anaesthetists and anaesthesiologists for colonoscopy and endoscopy procedures conducted on them. They also touched on the regional differences in the use of anaesthesiologists and how payment has been made for such procedures.

The study concluded that the use of anaesthesia for endoscopy and colonoscopy for both Medicare and private medical insurance patients grew from 14% in 2003 to 30% in 2009. About 2/3s of those patients were low risked ones. 13% of anaesthesia services were sought by those from the West and 59% from the Northeast region.

As anaesthesia was needed by patients, the cost also went up. For Medicare patients this is $150 on top of the procedure and $500 more for private medical insurance.  Researchers computed that at least $1.1 billion was spent for the anaesthesia component alone in 2009.

The researchers noted that the gastroenterological procedures and the utilization of anaesthesia have steadily grown between the years 2003 to 2009. They also noted that the use of anaesthesia by low-risk patients could have been discretionary and that endoscopy or colonoscopy procedures will most likely be monitored because of the continued rise of prices.

Another article by Lee A. Fleisher, MD, from the Department of Anaesthesiology and Critical Care at the Perelman School of Medicine, and Leonard Davis Institute of Health Economics at the University of Pennsylvania, Philadelphia, gave some possible reasons why anaesthesia is favoured among patients.

The article said that with anaesthesia endoscopists find it easier to do the procedure in less time. The latter reasons is one that is debatable said the article.  Patient preference and acceptance is also cited as a reason but this is something that is hard to measure.

Dr. Fleisher also cited there is a wide difference as we go from region to region. Northeastern patients prefer anaesthesia while those in the Southwest do not.  He said that this can also be due to the payment consideration. But no one is sure what the driving force for the differences is regionally.

When endoscopy is made, there is a cost for moderate sedation embedded on the procedure expense and when anaesthesia is resorted to, there is another cost for this.  This raises the cost of having the screening all the more. Dr. Fleisher says that it is vital to come up with a reasonable payment scheme for the procedures since people will opt not to have the screening due to its cost. Gastroenterologists and anaesthesiologists should come up with a way to provide the procedure as a whole and make it more affordable to the patient.

Lawrence B. Cohen, MD, associate professor, Mount Sinai School of Medicine, New York City says that the published articles were somewhat confusing and the used of the word “discretionary” might not be effective. He said that the article is implicit in its statement that anaesthesia using propofol is an option and may even be unnecessary.  He continued saying that it is not who and how much is being paid for this addition to the procedure but how the system provides high and quality sedation services to those undergoing endoscopy in a cost efficient manner.

Dr. David Shaffer who is the director of worldwide communications for the EES said that they are also financing a study for the computer- assisted personalized sedation system. He said that the reason behind the interest is to have knowledge and understanding of the health care environment.

The system called SEDASYS checks on patients who are having a propofol sedation and measuring psychologic parameters like heart rate, blood pressure, oxygen saturation and capnography. The system will give instructions to the patients to press a handheld button so the drug will be infused to them. Initially, the system was rejected for use by the FDA in 2010. But early this year, EES received a letter which approved the system but under certain conditions for full FDA approval. The system is not intended to replace anaesthesiologists or the team that involves such service. High-risk endoscopy and colonoscopy patients will always need anaesthesia along with the procedure.