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Research Letter |

Propofol for Screening Colonoscopy in Low-Risk Patients:  Are We Paying Too Much?

Deepak Agrawal, MD, MPH1; Don C. Rockey, MD2
[+] Author Affiliations
1Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center, Dallas
2Department of Internal Medicine, Medical University of South Carolina, Charleston
JAMA Intern Med. 2013;173(19):1836-1838. doi:10.1001/jamainternmed.2013.8417.
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Use of propofol for sedation for screening colonoscopy in low-risk patients has increased markedly recently.1,2 In the United States, propofol is administered only by an anesthesiology provider, which can substantially increase cost (typically $600-$2000). Given the number of screening colonoscopies performed every year, additional health care costs associated with this practice are substantial. The advantages of propofol over standard moderate sedation using a narcotic and/or benzodiazepine include quicker onset of action, a shorter half-life, and deeper level of sedation. However, evidence supporting the potential benefits of propofol is limited.3 For screening colonoscopy in low-risk patients, the question thus becomes, what is propofol worth? For a patient who has never had a colonoscopy, this is a very difficult question to answer, since it is challenging to associate a dollar amount to comfort without knowledge of the likely degree of discomfort. Hence, we approached this question by asking those who are most familiar with colonoscopy and sedation medications—namely gastroenterologists and endoscopy nurses.

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Figure.
Euler Diagrams Depicting Provider Reasons for Preferring Propofol

A, Gastroenterologists (n = 451). B, Endoscopy nurses (n = 460). The color-coded panel shows the key for the specific preference reasons. The letters represent a key for the specific reasons, and the numbers given represent percentages.

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