OBJECTIVES: This study investigates the cost-effectiveness and safety of Non-Anesthesiologist Administration of Propofol (NAAP) compared to Anesthesiologist Administration of Propofol (AAP) for outpatient endoscopy within the Italian Healthcare System. This study is designed in two phases: the first part involves conducting a preliminary analysis to compare the adverse event rates between NAAP and AAP using Target Controlled Infusion (TCI) at San Raffaele Hospital, Milan, Italy. The second part is focused on calculating the potential cost savings at both the local and national levels (Italian NHS) that could arise from the broad implementation of NAAP.

METHODS: Phase one involved a cohort study of low-risk patients (ASA scores 1 and 2) who underwent esophagogastroduodenoscopies (EGDs) and colonoscopies from May 2019 to November 2021. Propensity score matching was used to balance baseline characteristics between NAAP and AAP groups. Adverse events were monitored, including hypotension, hypoxia, agitation, and bradycardia. Phase two entailed developing a three-year budget impact model (BIM) from the Italian National Health System (NHS) perspective, comparing costs and resource utilization between NAAP and AAP.

RESULTS: The study included 2,721 EGDs and 2,748 colonoscopies. Post-matching, NAAP and AAP groups showed no significant difference in adverse events (EGD: NAAP 0.4% vs. AAP 1.0%, p=0.452; Colonoscopy: NAAP 3.5% vs. AAP 0.6%, p=0.249). NAAP was associated with higher patient satisfaction and lower propofol dosages. The BIM projected national savings of €124,724,659 over three years with NAAP implementation. NAAP reduced the average cost per EGD and colonoscopy due to decreased preparation and monitoring times, and lower drug usage costs.

CONCLUSIONS: NAAP is a safe, effective, and economically beneficial alternative to AAP for outpatient GI endoscopy. Implementing NAAP could result in substantial cost savings for the Italian NHS while maintaining high patient safety and satisfaction. Future policies should support NAAP adoption, addressing training, and regulatory challenges.