How the Propofol Shortage May Impact GI ASCs: Insight From Brien Fausone of Michigan Endoscopy Center

Q:  Propofol is increasingly used in GI procedures, especially colonoscopy, and is often thought of as adding a level of patient comfort and satisfaction. With the recent developments in the propofol shortage, how do you think this will affect the access ASCs have to propofol? Are there other anesthesia medications that offer the same level of satisfaction for GI procedures?

Brien Fausone: Yes, I agree that propofol has added a level of comfort to the GI patient. We often get positive patient comments post-procedure about the anesthesia. MEC uses propofol 95 percent of the time with conscious sedation representing the balance of anesthesia.

Regarding the access to propofol, we were aware of the shortage situation early on and have sought out alternative sources for the product. What we are finding now is that while propofol is still available, it is increasingly harder to find the optimum vial size that works for our setting. Too large a vial leads to wasting of the drug.

We are currently using Propoven, which was recently [reauthorized] by the FDA for importation. It is available through a sole distributor relationship (APP) and drop-shipped to us from Chicago. As more demand is placed on APP for Propoven, we are finding that our lead times are being pushed out and the quantity available to purchase is capped. From a provider/patient perspective, there is no difference in product. The anesthesia personnel have to screen the patients a bit closer for additional allergies.

Q: Do you think the increasing shortage of propofol will impact ASCs' revenues or case volumes in any way?

BF: We do not charge separately for the anesthesia in the ASC setting be it propofol or conscious sedation. Thus, the impact of the shortage is a non-issue regarding the drug. The exception would be if the ASC is billing for anesthesia services (propofol) and replaces this arrangement with a conscious sedation model where the attending GI physician administers the anesthesia. Then. there would be a reduction in anesthesia revenue.

Q: What other concerns do you have regarding the propofol shortage?

BF: Why is the marketplace taking so long to respond to this shortage? Several pharmaceutical companies have stopped making the drug: why? Increase manufacturing capacity or allow more off-shore product approved by the FDA.

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