Non-Anesthesiologist-Administered Propofol Sedation For Outpatient Endoscopy: Safety Analysis In A Tertiary Center And Economic Impact On The Italian Healthcare System

Aims Non-Anesthesiologist-Administered Propofol (NAAP) sedation for outpatient endoscopy has proven to be safe. However, implementing NAAP in Western countries faces challenges, and propofol-based sedation is still largely administered by anesthetists. For low-risk patients (ASA 1 and 2), Anesthesiologist-Administered Propofol (AAP) could represent an avoidable waste of healthcare resources.

Methods This research consisted of two phases. The first is a retrospective study comparing NAAP and AAP for outpatient endoscopy at a tertiary centre (San Raffaele Hospital, Milan, Italy), with the primary outcome being the rate of adverse events (AEs). The second phase involved a budget impact model (BIM) to assess the economic impact of using NAAP instead of AAP for low-risk patients, both locally and nationally, between the 2023 and 2025.

Results Between May 2019 and November 2021, 2,721 patients (ASA 1 and 2) undergoing esophagogastroduodenoscopies (EGDs) (NAAP 2,439 and AAP 282) and 2,748 colonoscopies (NAAP 2,491 and AAP 257) were enrolled. Overall, the AE rates were similar between the cohorts (EGDs: NAAP 1.1% vs. AAP 0.8%, p=0.81; colonoscopies: NAAP 1.8% vs. AAP 3.5%, p=0.20). All NAAP-related AEs were minor. The BIM showed that over the 2023-2025 triennium, the use of NAAP instead of AAP would result in savings of €851,649 (€283,266 in 2023, €283,927 in 2024, and €284,455 in 2025) at San Raffaele Hospital; €8,301,589 (€2,761,249 in 2023, €2,767,635 in 2024, and €2,772,704 in 2025) at the Health Protection Agency of Milan; and €19,782,147 (€7,040,807 in 2023, €7,057,045 in 2024, and €5,684,295 in 2025) in Lombardy. Nationally, the implementation of NAAP instead of AAP is projected to potentially lead to cumulative savings of €124,724,659 (€41,627,595 in 2023, €41,587,421 in 2024, and €41,509,643 in 2025). For the Italian NHS, the use of NAAP instead of AAP would also result in savings of €28,510,374 in drug costs and a reduction in staff workload equivalent to 2,223 working days over the 2023-2025 period.

Conclusions NAAP has a comparable AE rate to AAP for low-risk outpatient endoscopy. Implementing NAAP instead of AAP could save over €100 million and 2,000 working days for the Italian National Health System between 2023 and 2025. Wider adoption of NAAP could lead to improved resource allocation in healthcare.

Publication History

Article published online:
27 March 2025