Title: Cost analysis of propofol and remifentanil analgosedation vs total intravenous anaesthesia for ambulatory colonoscopy
- Robert Rudner, Przemysław Jałowiecki, Piotr Kawecki, Maciej Gonciarz, Aldona Mularczyk, Michał Petelenz
- Original articles
- Polish Gastroenterology
- Start page:
- Final page:
- cost analysis, colonoscopy, total intravenous anaesthesia, analgosedation, remifentanil
Objectives: Comparison of costs of total intravenous anaesthesia and conscious analgosedation for ambulatory colonoscopy.
Material and methods: Pharmacoeconomical analysis based on data received from prospective, controlled, ran-domised study in the group of 100 patients allowed for colonoscopies conducted in the out-patient's clinic, where 4-5 colonoscopies are performed daily. Patients in the F group (n=50) received single doses of fen-tanyl (2 ug/kg) and midazolam (0.05 mg/kg) and titrated doses of propofol in the way that bispectral index (BIS) is 60±10. Patients in the R group (n=50) received analgosedation by continuous infusion of remifentanil (0.2 ug/kg/min) and titrated doses of propofol to maintain the lll° of Ramsa^s sedation scalę. The costs of used medication and disposable equipment were calculated including their lowest, highest and ave-rage prices. We took into consideration the capital allowance of durable facilities. We excluded identical items for both groups.
Results: No demographic differences were found among the groups and both groups were similar with re-spect to initial parameters and duration of colonoscopy (p>0.05). The lowest, highest and average costs were: in R group - 4.14 and 25.00 (12.80±4.54) PLN and in Fgroup - 9.39 and 38.63 (17.56±6.94) PLN, respectively (p<0.05). Conscious analgosedation was on average 4.76 PLN cheaper than total intraveno-us anaesthesia. Propofol tookthe greatest part in the costs (R: 47.2%, F: 72.93%). The use of 2.5 times cheaperingenuineformof thisdrug resulted in the same expense in both groups(p>0.05). Assuming atle-ast 1000 analgosedations per year, the cost of infusion pump use did not exceed 7% of the overall costs in the R group. Conclusions:
1. Analgosedation with remifentanil and propofol could be a cheaper method of providing a patient with comfort during colonoscopy compared to intravenous anaesthesia.
2. The usage of infusion pump does not significantly increase the costs of above described method of analgosedation when at least 4-5 colonoscopies a day are performed.