Most Gastroenterologists and Endoscopy Nurses Prefer Propofol Over Moderate Sedation in Screening Colonoscopies, but Would Pay Little Extra for It
Propofol is increasingly being used for sedation in screening colonoscopies in low-risk patients. In the United States, propofol can be administered only by an anesthesiologist, which can raise the cost of the procedure by $600 to $2,000. In a study reported in a research letter in JAMA Internal Medicine, Deepak Agrawal, MD, MPH, Assistant Professor at the University of Texas Southwestern Medical Center in Dallas, and Don C. Rockey, MD, Professor and Chairman of the Department of Medicine at the Medical University of South Carolina in Charleston, surveyed gastroenterologists and endoscopy nurses about their preferences regarding sedation if they were to undergo screening colonoscopy. The physicians and nurses were asked whether they would rather receive propofol (deep sedation) vs moderate sedation with midazolam-fentanyl or no sedation and how much extra they would be willing to pay for propofol. Most respondents favored propofol but were unwilling to pay more than $100 extra for it.
Survey Results
Responses were received from 451 gastroenterologists (87% response rate for directly distributed questionnaires and 23% for Web-based distribution) and 460 nurses (84% response rate for directly distributed questionnaires). Among gastroenterologists, 53% said they preferred propofol, 34% preferred midazolam-fentanyl, and 13% preferred no sedation. Among those who preferred propofol, 38% were not willing to pay any extra for it, 32% were willing to pay $1 to $100 extra, and 15% were willing to pay $101 to $200 extra. Among nurses, 70% would prefer propofol and 26%, midazolam-fentanyl. Among those preferring propofol, 19% were not willing to pay extra for it, 44% were willing to pay $1 to $100 extra, and 13% were willing to pay $101 to $200 extra.
The reasons respondents gave for preferring propofol included, “I do not want to feel anything” (78% of gastroenterologists and 91% of nurses), “My recovery time will be faster” (89% of gastroenterologists and 69% of nurses), and “I want to be taken care of by an anesthesiologist/certified registered nurse anesthetist” (11% of gastroenterologists and 35% of nurses). Most respondents had multiple reasons for preferring propofol over midazolam-fentanyl.
Is Extra Cost Fair?
The authors noted that there is evidence that propofol sedation is not associated with any greater pain prevention than moderate sedation. “Insurers often do not cover the entire cost of propofol administration, and patients often end up paying considerable (>$1,000) amounts for this service,” wrote the authors. “Thus, it behooves us to ask, is it fair for a gastroenterologist to ask a patient to pay more for a service than what she or he is willing to pay? Would patients react differently if they were told that many gastroenterologists prefer moderate sedation or that 70% would not pay more than $100 for propofol? Perhaps information such as this should be part of the informed consent process. Furthermore, even when patients may not have to pay extra, is the additional expense to the health care system justifiable?”
Dr. Rockey is the corresponding author for the JAMA Internal Medicine research letter.
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