As insurance giant Aetna plans to eliminate coverage for a powerful anesthetic used sometimes during colonoscopies, doctors are locked in debate over whether such a move is appropriate.
The drug propofol, also known by the trade name Diprivan, is more powerful than other sedatives traditionally used to help patients endure the discomfort of a colonoscopy in which a flexible tube is inserted into the lower intestine to search for potentially cancerous growths.
Some doctors say that the drug sedates patients more completely during the procedure -- and allows them to recover more quickly afterward. But the powerful effects of the drug usually necessitate the presence of a qualified anesthesiologist during the procedure, which can add between $250 and $400 to the total cost of the screening.
On Friday, Aetna sent a letter to doctors announcing its plans to classify the drug as "medically unnecessary" for most colonoscopies. On April 1, the company intends to stop paying for its use in these cases.
Dr. Donald David, director of gastroenterology at the City of Hope National Medical Center in Duarte, Calif., says he believes the pullback is a step in the right direction when it comes to controlling costs.
"I think that this is not unreasonable, as the cost of this kind of sedation often exceeds the entire payment to the [gastroenterologist] for the procedure," he says.
"Since this does not affect the great majority of patients who are having this done -- painlessly and without recollection for the procedure I might add -- this is not a bad thing as long as they cover it for the select few who need it. The money saved could be used to screen more individuals."
Others note that doctors have a number of alternatives when it comes to sedation during a colonoscopy.
"At present, there is no evidence that the use of propofol leads to better clinical outcomes," says Dr. David Weinberg, chairman of the department of medicine at Fox Chase Cancer Center in Philadelphia. "In most cases, it is not necessary. Colonoscopies were and are performed without this particular drug all the time."
But a number of doctors say the move by the insurance company could eliminate a useful tool.
"Patient satisfaction is much higher with propofol, and this is borne out in numerous studies," says Dr. David Posner, chief of gastroenterology at Mercy Medical Center in Baltimore.
"I have had two colonoscopies, one with the usual moderate sedation," he says. "I was hung over for four to six hours afterward. The second was with propofol, and I was awake and fully aware within 15 minutes and went shopping with my wife right after we left the facility. That is the entire difference."
And Dr. James Cottrell, chairman of anesthesiology at Downstate Medical Center in Brooklyn, N.Y., and past president of the American Society of Anesthesiologists, says that the move trespasses dangerously into the doctor-patient relationship.
"I don't think that the insurance companies can decide what is and isn't medically unnecessary," Cottrell says.
"This shouldn't be about whether an insurance company approves of or disapproves of a procedure. It really should be about the doctor and the patient."