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The Impact on Endoscopic Resource Utilization After a Targeted Intervention for Cost-Minimization of EGD and Colonoscopy

Kaitha, Sindhu R MD1; Salem, George MD2; Zhao, Yan D PhD3; Madhoun, Mohammad F MD1; Chen, Allshine MS3; Tierney, William M MD1

American Journal of Gastroenterology: November 2016 - Volume 111 - Issue 11 - p 1559–1563
doi: 10.1038/ajg.2016.340
ORIGINAL CONTRIBUTIONS: ENDOSCOPY
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Objectives: The need to define the cost of endoscopic procedures becomes increasingly important in an era of providing low-cost, high-quality care. We examined the impact of informing endoscopists of the cost of accessories and pathology specimens as a cost-minimization strategy.

Methods: We conducted a prospective observational cohort study of therapeutic outpatient esophagogastroduodenoscopy (EGD) and colonoscopy. During the pre-intervention phase (phase 1), the endoscopists were not briefed on the cost of accessories or pathology specimens obtained during the procedure. During a 3-week intervention phase and the post-intervention phase (phase 2) endoscopists were informed of the dollar value of accessories and pathology specimens after the completion of all procedures. In all cases the institutional costs (not charges) were used. The endoscopists were blinded to their observation.

Results: A total of 969 EGD, colonoscopy, and EGD+colonoscopy performed by 6 endoscopists were reviewed, 456 procedures in phase 1 and 513 procedures in phase 2. There was no significant difference between phases 1 and 2 in total device and pathology cost in dollars (188.8±151.4 vs. 188.9±151.8,P=0.99), total device cost (36.2±107.9 vs. 39.0±95.96,P=0.67) and total pathology cost (152.6±101.3 vs. 149.9±112.5,P=0.70). There was not a significant difference in total device and pathology cost when examined by specific procedures performed, or for any of the endoscopists between phases 1 and 2.

Conclusions: Making endoscopists more cost conscious by informing them of the costs of each procedure during EGD and colonoscopy does not result in lower procedural costs. Analysis of cost-minimization strategies involving procedures in other health-care settings and procedures using high-cost accessories are warranted.

1Department of Internal Medicine, Section of Digestive Diseases, University of Oklahoma Health Sciences Center, OUHSC, Oklahoma City, Oklahoma, USA

2Department of Internal Medicine, University of Oklahoma Health Sciences Center, OUHSC, Oklahoma City, Oklahoma, USA

3Department of Biostatistics, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA

Correspondence: William M. Tierney, MD, Department of Internal Medicine, Section of Digestive Diseases, University of Oklahoma Health Sciences Center, 920 Stanton L. Young Boulevard, WP 1345, Oklahoma City, Oklahoma 73104, USA. E-mail: william-tierney@ouhsc.edu

Received 15 March 2016; accepted 13 July 2016

Guarantor of the article: William M. Tierney, MD.

Specific author contributions: Study concept, design, and supervision, drafting of the manuscript, and critical revision of the manuscript for important intellectual content: William M. Tierney and Sindhu R. Kaitha; acquisition of data: Sindhu R. Kaitha and George Salem; analysis and interpretation of data: Yan D. Zhao, Allshine Chen, Mohammad F. Madhoun, William M. Tierney, Sindhu R. Kaitha; statistical analysis: Yan D. Zhao, Allshine Chen, Mohammad F. Madhoun. All authors approved the final draft. William M. Tierney, Sindhu R. Kaitha, and George Salem had full access to all the data in the study, and take responsibility for the integrity of the data and the accuracy of the data analysis.

Financial support: None.

Potential competing interests: None.

© The American College of Gastroenterology 2016. All Rights Reserved.
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