Imperfect bowel preparation increases colonoscopy costs considerably

Imperfect bowel preparation substantially increases colonoscopy costs, according to research published in the July issue of the American Journal of Gastroenterology.

A team from Indianapolis, Indiana, USA, measured the impact of bowel preparation on the efficiency and cost of colonoscopy.

The study included 200 consecutive outpatient colonoscopies in patients with intact colons, both at a private university hospital and at a public university hospital.

The time spent suctioning fluid and feces from the colon and the time spent washing the colon to clean the mucosa were recorded.

Colonoscopists were prospectively asked to designate examinations that should be repeated at an interval sooner than would otherwise be recommended because of imperfect preparation.

A cost analysis of the economic effect of bowel preparation on direct costs of colonoscopy was also conducted.

The researchers found that suctioning fluid and washing occupied 6% and 1.5%, respectively, of total examination time (including insertion and withdrawal) at the public hospital. These figures were 9% and 1.3% at the private hospital.

Patients at the public hospital were more likely to have an aborted examination (6.5% vs 1%).

Cost increase from imperfect preparation: University hospital: 12% Public hospital: 22%

American Journal of Gastroenterology

They also had a greater chance of being brought back earlier than suggested or required by current practice standards because of imperfect bowel preparation (20% vs 12.5%).

Cost analysis indicated that to complete the initial examinations and the first round of surveillance, imperfect bowel preparation resulted in a 12% increase in costs at the university hospital and a 22% increase at the public hospital.

Dr Douglas K. Rex, of the Indiana University Medical Center, said on behalf of his colleagues, "The increase in colonoscopy costs associated with imperfect preparation is substantial, and seems likely to vary among practices.

"Aborted examinations and surveillance examinations performed earlier than recommended because of imperfect preparation are appropriate targets for continuous quality improvement programs," he added.

"More reliable bowel preparations, or measures to improve patient compliance with bowel preparation, could significantly reduce the costs of colonoscopy in clinical practice," he concluded.

In an accompanying Editorial, Michael F. Byrne, of Duke University Medical Center, Durham, North Carolina, USA, comments, "The study supports a widely held belief that further advances are required both in the administration of bowel preparation and in the type of preparation used.

"The present situation is not ideal. Further measures to improve patient compliance via education and improving the presentation and tolerability of the preparation are very appropriate and indeed achievable goals."

"These measures would undoubtedly translate into significant cost savings, lead to a decrease in procedure-related morbidity and mortality, and increase confidence in adoption of screening guidelines," he concludes.