Increased use of anesthesiologists in screening colonoscopy found to raise costs, but risks and benefits are still unknown
Research Activities, November 2012, No. 387
The involvement of anesthesiologists in screening colonoscopies for Medicare patients more than doubled from 2001, when Medicare began paying for this service, through 2006, according to a new study. This screening test provides physicians with the ability to find and remove colon polyps before they can develop into colorectal cancer (CRC), a disease that is associated with almost 50,000 deaths annually in the United States. Screening guidelines, issued by the Centers for Disease Control and Prevention, recommend a colonoscopy every 10 years in patients over age 50 as one of several effective screening techniques for identification of CRC or treatable precancerous polyps in persons without symptoms. In the past, a combination of midazolam and an opioid have been used to sedate patients undergoing screening colonoscopy, but an increasing number of patients are being sedated with propofol, a drug typically administered by an anesthesiologist.
The researchers conducting the study analyzed Medicare payments for screening colonoscopy for a sample of 16,268 Medicare patients without a history of CRC over a 5-year period. They found that the involvement of anesthesiologists in screening colonoscopy grew from 11.0 percent of these procedures in 2001 to 23.4 percent in 2006. Screening procedures performed by a surgeon were most likely (24.2 percent) to involve an anesthesiologist, compared with 18.0 percent for those done by gastroenterologists, and 11.3 percent when done by primary care providers. The average cost for a screening colonoscopy performed with and without the involvement of an anesthesiologist was $678.30 versus $575.20. Based on their findings, the researchers recommend that a new analysis be done to calculate the incremental cost-effectiveness per life saved by current recommendations for screening colonoscopy.
Their findings were based on data on patients not diagnosed with cancer from the Surveillance, Epidemiology, and End Results-Medicare database for 2001 through 2006. The study was funded in part by the Agency for Healthcare Research and Quality (HS17624).
More details are in "Anesthesiologist involvement in screening colonoscopy: Temporal trends and cost implications in the Medicare population," by Vijay S. Khiani, M.D., Pamela Soulos, M.P.H., John Gancayco, M.D., and others in the January 2012 Clinical Gastroenterology and Hepatology 10(1), pp. 58-64.