Impact of Non-Anesthesiologist-Administered Propofol Sedation for Outpatient Endoscopy in the Healthcare System

Introduction: 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, 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 center, with the primary outcome being the rate of adverse events (AEs). Propensity score matching was performed to balance baseline characteristics between the two groups. The second phase involved a budget impact model to assess the economic impact of using NAAP instead of AAP for low-risk patients, both locally and nationally, between 2023 and 2025. Results: Between May 2019 and November 2021, 2721 patients undergoing esophagogastroduodenoscopies (EGDs; NAAP 2439 and AAP 282) and 2748 colonoscopies (NAAP 2491 and AAP 257) were enrolled. Overall, the AE rates were similar between the cohorts (esophagogastroduodenoscopies: 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 budget impact model revealed that adopting NAAP instead of AAP would save €124,724,659 and 2223 working days for healthcare professionals for the Italian National Health System (NHS) between 2023 and 2025. Conclusion: NAAP has a comparable AE rate to AAP for low-risk outpatient endoscopy. Implementing NAAP instead of AAP could save over €100 million and 2000 working days for the Italian NHS between 2023 and 2025. Wider adoption could improve healthcare resource allocation.