Tu1730 Cost-Effectiveness of Colonoscopies Performed by Nurse Endoscopists

Nurse-Performed Endoscopy

“…A number of randomized control trials (RCTs), descriptive surveys, and retrospective and prospective studies comparing nurse and physician endoscopy outcomes indicate comparable performance on a range of measures. Among these measure are procedure duration, complication rates, detection and diagnosis rates, and patient pain and discomfort (e.g., Koornstra, Corporaal, Giezen-Beintema, de Vries, & van Dullemen, 2009; Limoges-Gonzalez et al., 2011; Massl et al., 2014; Maule, 1994; Meaden, Joshi, Hollis, Higham, & Lynch, 2006; Van Putten, Massl, et al., 2012). A systematic review and meta-analysis by Day, Siao, Inadomi, and Somsouk (2014) found nine studies that directly compared physician and nonphysician (nurse or physician’s assistant) endoscopy (mostly flexible sigmoidoscopy) and found no significant differences in the detection and removal of polyps, adenoma detection rates, depth of insertions, total procedure times for flexible sigmoidoscopy, or adverse event rate.…”

“…For example, a Canadian study using cost-minimization analysis confirmed that nurses are a less costly alternative to physicians performing flexible sigmoidoscopy (Costa, Coyte, Laporte, Quigley, & Reynolds, 2012). A study in the Netherlands found that diagnostic colonoscopies performed by nurses (€17.43 [US$20] per procedure) were more cost effective than those done by a GI (€29.03 [US$33] per procedure; Van Putten, Massl, et al., 2012). In contrast, an RCT in the United Kingdom from 2002 to 2003 found that endoscopies performed by physicians cost more per procedure than nurses due to physicians’ higher salary and resource use.…”