PMID- 27004254
OWN - NLM
STAT- PubMed-not-MEDLINE
DCOM- 20160323
LR  - 20240325
IS  - 2364-3722 (Print)
IS  - 2196-9736 (Electronic)
IS  - 2196-9736 (Linking)
VI  - 4
IP  - 3
DP  - 2016 Mar
TI  - Modeling the costs and benefits of capnography monitoring during procedural 
      sedation for gastrointestinal endoscopy.
PG  - E340-51
LID - 10.1055/s-0042-100719 [doi]
AB  - BACKGROUND AND STUDY AIMS: The addition of capnography to procedural 
      sedation/analgesia (PSA) guidelines has been controversial due to limited 
      evidence of clinical utility in moderate PSA and cost concerns. PATIENTS AND 
      METHODS: A comprehensive model of PSA during gastrointestinal endoscopy was 
      developed to capture adverse events (AEs), guideline interventions, outcomes, and 
      costs. Randomized, controlled trials and large-scale studies were used to inform 
      the model. The model compared outcomes using pulse oximetry alone with pulse 
      oximetry plus capnography. Pulse oximetry was assumed at no cost, whereas 
      capnography cost USD 4,000 per monitor. AE costs were obtained from literature 
      review and Premier database analysis. The model population (n = 8,000) had mean 
      characteristics of age 55.5 years, body mass index 26.2 kg/m(2), and 45.3 % male. 
      RESULTS: The addition of capnography resulted in a 27.2 % and 18.0 % reduction in 
      the proportion of patients experiencing an AE during deep and moderate PSA, 
      respectively. Sensitivity analyses demonstrated significant reductions in apnea 
      and desaturation with capnography. The median (95 % credible interval) number 
      needed to treat to avoid any adverse event was 8 (2; 72) for deep and 6 (-59; 92) 
      for moderate. Reduced AEs resulted in cost savings that accounted for the 
      additional upfront purchase cost. Capnography was estimated to reduce the cost 
      per procedure by USD 85 (deep) or USD 35 (moderate). CONCLUSIONS: Capnography is 
      estimated to be cost-effective if not cost saving during PSA for gastrointestinal 
      endoscopy. Savings were driven by improved patient safety, suggesting that 
      capnography may have an important role in the safe provision of PSA.
FAU - Saunders, Rhodri
AU  - Saunders R
AD  - Ossian Health Economics and Communications, Basel, Switzerland (current 
      affiliation: Coreva Scientific, Freiburg, Germany).
FAU - Erslon, Mary
AU  - Erslon M
AD  - Covidien, Boulder, Colorado, United States (current affiliation: Medtronic, 
      Boulder, Colorado, United States).
FAU - Vargo, John
AU  - Vargo J
AD  - Cleveland Clinic, Cleveland, Ohio, United States.
LA  - eng
PT  - Journal Article
PL  - Germany
TA  - Endosc Int Open
JT  - Endoscopy international open
JID - 101639919
PMC - PMC4798929
COIS- Competing interests: Rhodri Saunders was a full-time employee of Ossian Health 
      Economics and Communications (Basel, Switzerland), which received consultancy 
      fees for work developing the health econnomic model. Rhodri is now director of 
      Coreva Scientific GmbH & Co. KG. (Freiburg, Germany), which has consultancy 
      contracts with Medtronic Inc. Mary Erslon is a full-time employee of Medtronic 
      Inc. John Vargo is a physician who has consulted for multiple medical devices and 
      pharmaceutical companies. Dr Vargo received no payment for work on this research 
      project or manuscript.
EDAT- 2016/03/24 06:00
MHDA- 2016/03/24 06:01
PMCR- 2016/03/01
CRDT- 2016/03/23 06:00
PHST- 2016/03/23 06:00 [entrez]
PHST- 2016/03/24 06:00 [pubmed]
PHST- 2016/03/24 06:01 [medline]
PHST- 2016/03/01 00:00 [pmc-release]
AID - 10.1055/s-0042-100719 [doi]
PST - ppublish
SO  - Endosc Int Open. 2016 Mar;4(3):E340-51. doi: 10.1055/s-0042-100719.