Anesthesiologist involvement in screening colonoscopy increased the cost of the procedure by about $100, or nearly 20%, wrote Dr. Vijay S. Khiani and his colleagues in the January issue of Clinical Gastroenterology and Hepatology.
Moreover, the percentage of screening colonoscopies with anesthesiologist involvement more than doubled over the period from 2001 to 2006, representing "a significant change in practice," wrote the authors.
Dr. Khiani of Yale University in New Haven, Conn., and his colleagues used the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) Medicare linked database, which provides a compilation of data from geographic areas that represent approximately 28% of the U.S. population.
Patients were included in the study if they underwent a screening colonoscopy between 2001 and 2006, were on Medicare for at least 3 years prior to the screening, and had not had a prior screening within 3 years (Clin. Gastroenterol. Hepatol. 2011 [doi:10.1016/j.cgh.2011.07.005]).
Screening colonoscopies, as opposed to diagnostic colonoscopies, were defined as those performed in an outpatient setting without use of ICD-9 codes for gastrointestinal tract symptoms, weight loss, iron deficiency anemia, alteration in bowel habits, or gastrointestinal bleeding reported at any physician visits within the previous 3 months.
During the study period, there were 16,268 screening colonoscopies. Slightly more than half of the patients were female and 40% were between 70 and 74 years of age. Most (90%) were white, and more than 75% of the procedures were performed by a gastroenterologist.
Overall, 17.2% of these colonoscopies had anesthesiologist involvement, wrote the authors, with increases in anesthesiologist use over time. In 2001, 11.0% of claims included an anesthesiologist, whereas in 2006, the proportion was 23.4%.
The authors also found that involvement of an anesthesiologist varied according to provider characteristics. For example, "surgeons had anesthesiologist involvement in 24.2% of screening colonoscopies, compared to 18.0% in gastroenterologists and 11.3% in primary care providers."
Looking at regional characteristics, "Anesthesiologist involvement by registry ranged from 1.6% in San Francisco to 57.8% in New Jersey," they wrote. Utah; Seattle, Wash.; and San Jose, Calif., Medicare claims markets also logged low anesthesiologist usage rates, while Detroit and Los Angeles registered some of the highest.
Finally, the authors looked at cost. The average price tag for procedures without anesthesiologist involvement was $575.20, they wrote, compared with $678.20 with an anesthesiologist.
Based on those figures, they then calculated the total cost to Medicare during the study period for all screening colonoscopies nationally, assuming no anesthesiologist involvement: The total was $668,382,400.
However, assuming the 17.2% average anesthesiologist usage rate seen in this study, the total national cost to Medicare jumped to $688,968,392 – more than a $20 million increase.
The authors highlighted a recent position statement by the American Society for Gastrointestinal Endoscopy stating that "the use of anesthesiologist-administered propofol for healthy individuals undergoing elective endoscopy is very costly without demonstrated improvement in patient safety or procedural outcome." Dr. Khiani and his colleagues also noted that endoscopist-directed administration of propofol has been shown to be safe.
"An investigation of the potential benefits, including polyp detection rate, and potential risks, including the complication rate, with and without anesthesiologist involvement may help to determine the most safe and cost-effective approach to screening colonoscopies," Dr. Khiani and his associates concluded.
The study was funded by the National Institutes of Health. The authors made no individual disclosures.