title: Practice efficiency and economics: the case for rapid recovery sedation agents for colonoscopy in a screening population.
abstract: OBJECTIVE
  To determine rapidly acting agents' impact on practice efficiency and cost for outpatient colonoscopy in a screening population.
  
  
  BACKGROUND
  Propofol-mediated endoscopic sedation is popular due to rapid sedation onset and superior recovery profile compared with sedation with an opioid and benzodiazepine. There are few data on the impact of this type of sedation on the economics and efficiency of an endoscopy unit.
  
  
  METHODS
  A provider-perspective economic model assessed the ability of propofol and fospropofol disodium (Aquavan, GPI 15715, MGI Pharma) to increase practice efficiency and determined break-even costs based on current colonoscopy reimbursement levels. Reimbursement inputs by practice setting, costs, and recovery profiles-taken from published literature examining time to discharge-were used to populate the model. To measure robustness of model results to changes in base case inputs, sensitivity analyses were performed. Using a Monte Carlo simulation, inputs were varied simultaneously and randomly for 1000 iterations to determine 95% confidence intervals (CI) for break-even costs.
  
  
  RESULTS
  In the time to complete 1 colonoscopy with midazolam/meperidine, 1.76 colonoscopies can be completed with propofol and 1.91 colonoscopies can be completed with fospropofol disodium. This efficiency benefit produced a break-even cost for rapid recovery agents of $71.53 (95% CI: $38.39, $105.67) in a hospital outpatient clinic and $61.48 (95% CI: $41.33, $108.99) in an ambulatory surgical center. One-way sensitivity analyses indicated the break-even cost of these agents was most sensitive to operating costs and time to discharge ratio.
  
  
  CONCLUSIONS
  Rapid recovery agents for colonoscopy can improve practice efficiency and offer economic advantages over traditional sedation.
authors.affiliation: Department of Gastroenterology and Hepatology, The Cleveland Clinic Foundation, Cleveland, OH, USA.
authors.forename: John J
authors.initials: JJ
authors.lastname: Vargo
authors.forename: Thomas
authors.initials: T
authors.lastname: Bramley
authors.forename: Kellie
authors.initials: K
authors.lastname: Meyer
authors.forename: Brian
authors.initials: B
authors.lastname: Nightengale
mesh_terms: D003113:Colonoscopy / Q000191:economics*; D016292:Procedural Sedation / Q000191:economics*; D017598:Efficiency, Organizational; D006801:Humans; D006993:Hypnotics and Sedatives / Q000191:economics*; D008403:Mass Screening / Q000191:economics / Q000458:organization & administration*; D006278:Medicare / Q000191:economics; D018803:Models, Economic; D009010:Monte Carlo Method; D015742:Propofol / Q000031:analogs & derivatives* / Q000191:economics; D014481:United States
chemical_list: D006993:Hypnotics and Sedatives; C472965:fospropofol; D015742:Propofol