Sedation is not required to perform a technically adequate gastroscopy (EGDE). However, it does improve patient satisfaction, comfort, and willingness to repeat the procedure in some patients.
In this study, doctors from North America compared the cost-efficacy of diagnostic EGDE with and without sedation in an adult ambulatory Canadian population.
The team randomized 429 patients to EGDE with either sedation or placebo.
|76% of patients in the sedation group underwent a "successful" procedure.|
|American Journal of Gastroenterology|
The team rated the success of the EGDE from 1 (inadequate) to 4 (totally adequate). The patients rated their comfort from 1 (acceptable) to 5 (unacceptable).
Secondary outcomes included recovery room time, patient satisfaction alone, and willingness to repeat the procedure.
The team obtained cost data using a published, institutional activity-based costing methodology.
The doctors found that 76% of patients in the sedation group underwent a "successful" procedure, versus 46% in the placebo group.
In addition, 79% of patients in the sedation group were satisfied with their level of comfort, compared to 47% in the placebo group.
More patients in the sedation group were willing to repeat the procedure (81% versus 65%).
The team observed a 10% crossover rate from placebo to active medications.
Overall, the doctors found that the use of sedation was the major determinant of successful endoscopy (OR = 3.8), but contributed to an increased recovery room time.
However, the expected cost of an additional successful endoscopy using sedation was $90.06 (CDN).
In a planned subgroup analysis, the team found that unsedated endoscopy was the dominant approach in patients over 75 years old.
The team observed a trend favoring the effectiveness of placebo (63%) versus active medication (57%) resulting in $450 savings per unsedated EGDE.
Dr Neena Abraham and colleagues concluded, "In the average Canadian ambulatory adult population, sedated diagnostic EGDE is more costly but remains an efficacious strategy".
"However, among the elderly…an unsedated strategy may be more cost-efficaciou