Vargo John J, Bramley Thomas, Meyer Kellie, Nightengale Brian
Department of Gastroenterology and Hepatology, The Cleveland Clinic Foundation, Cleveland, OH, USA.
J Clin Gastroenterol. 2007 Jul;41(6):591-8. doi: 10.1097/01.mcg.0000225634.52780.0e.
To determine rapidly acting agents' impact on practice efficiency and cost for outpatient colonoscopy in a screening population.
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.
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.
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.
Rapid recovery agents for colonoscopy can improve practice efficiency and offer economic advantages over traditional sedation.
确定快速起效药物对筛查人群门诊结肠镜检查的操作效率和成本的影响。
与阿片类药物和苯二氮䓬类药物镇静相比，丙泊酚介导的内镜镇静因起效迅速和恢复情况良好而广受欢迎。关于这类镇静对内镜科室的经济性和效率的影响的数据很少。
一个从提供者角度的经济模型评估了丙泊酚和磷丙泊酚二钠（Aquavan，GPI 15715，MGI制药公司）提高操作效率的能力，并根据当前结肠镜检查的报销水平确定了盈亏平衡成本。从已发表的关于出院时间的文献中获取的按操作环境、成本和恢复情况分类的报销数据被用于填充模型。为了衡量模型结果对基础病例输入变化的稳健性，进行了敏感性分析。使用蒙特卡罗模拟，对输入值同时进行1000次随机变化，以确定盈亏平衡成本的95%置信区间（CI）。
在使用咪达唑仑/哌替啶完成1次结肠镜检查的时间内，使用丙泊酚可完成1.76次结肠镜检查，使用磷丙泊酚二钠可完成1.91次结肠镜检查。这种效率优势使得快速恢复药物在医院门诊诊所的盈亏平衡成本为71.53美元（95% CI：38.39美元，105.67美元），在门诊手术中心为61.48美元（95% CI：41.33美元，108.99美元）。单向敏感性分析表明，这些药物的盈亏平衡成本对运营成本和出院时间比最为敏感。
用于结肠镜检查的快速恢复药物可提高操作效率，并比传统镇静具有经济优势。
