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The Catalyst

Questions about anesthesia in low-risk colonoscopy patients

In a research letter appearing in JAMA Internal Medicine, Don C. Rockey, M.D., MUSC Department of Medicine chair and gastroenterologist, and Deepak Agrawal, M.D., assistant professor at the University of Texas Southwestern Medical Center, suggest a misalignment of value and costs associated with heavy sedation for low-risk colonoscopy patients.

“We need to be transparent about this,” Rockey said. “Patients might feel differently about using heavy sedation if they knew that pain scores were not different from moderate sedation. They might also feel different about using heavy sedation if they knew that they were paying thousands of dollars for something that their provider values at less than a couple hundred dollars.”

Dr. Don Rockey
Dr. Don Rockey

The authors noted the increased use of a heavy sedation medication, propofol, during colonoscopy for low-risk patients in recent years, which can only be administered by an anesthesiologist. The authors question whether the perceived benefits of deeper sedation, such as quick onset and a shorter half-life in terms of lingering effects, offer the same value to low-risk patients and those who provide their care.

Rockey and Agrawal received responses to a three-question survey from 451 gastroenterologists and 460 nurses, gauging their preferred sedation level, their perceived monetary value of propofol if they indicated that preference and why they preferred it over other types of sedation. They found that although deep sedation was preferred among gastroenterologists and endoscopy nurses, most were unwilling to pay more than $200 for the service, far below what most patients pay for the same service.

As Rockey and Agrawal said in their article regarding the survey, “Insurers often do not cover the entire costs of propofol administration and patients often end up paying considerable amounts for this service. Thus, it behooves us to ask, is it fair for a gastroenterologist to ask a patient to pay more for a service than what he or she is willing to pay?...(and) furthermore, even when patients may not have to pay extra, is the additional expense to the health care system justifiable?”

The abstract is available here:

July 31, 2013

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