OBJECTIVES: Capnography monitoring is recommended during moderate sedation, although its uptake has been restricted by concerns over excess costs and demonstration of safety benefit. This analysis investigates the cost‑effectiveness of capnography for moderate sedation during gastrointestinal endoscopy. METHODS: Randomized clinical trial (RCT) and large‑scale study data were used to build a model of moderate sedation for endoscopic procedures that compared outcomes using pulse oximetry alone with pulse oximetry plus capnography. Adverse events (AEs) considered included apnea, bradycardia, desaturation, and hypotension. Interventions to treat AEs were taken from guidelines with costs derived from the Premier database and literature review. Adverse outcomes included unplanned admission and mortality. Odds ratio for events with capnography were taken from RCTs and a meta-analysis, where available, data specific to moderate sedation were used. The model base case assumed no progression into deep sedation and patients with mean characteristics of age 55 years, body mass index 26 kg/m, and 45% male. Probabilistic sensitivity analyses were performed. RESULTS: In the base case, utilization of capnography reduced the proportion of patients experiencing ≥1 AE by 18.0% and resulted in 1 AE of any severity being avoided every 9 procedures. The mean number needed to treat (95% credible interval [CrI]) to avoid an apnea or severe desaturation AE was 27 (−109–409) and 17 (4–308), respectively. Due to the reduction in AEs, capnography resulted in a saving of $55 (95% CrI −96–247) per procedure at 1 year. The key cost driver was reduced use of airway interventions with capnography. Assuming that AEs did not incur costs; capnography increased the cost per procedure by $9, costing $83 per adverse event avoided. CONCLUSIONS:

Capnography is likely to be cost-effective for monitoring moderate sedation even without considering progression to deep sedation.  Estimates indicate that it may also be cost saving.