Abstract
Background and study aims:
Single-use duodenoscopes
can prevent transmission of microorganisms through contaminated reusable duodenoscopes. Concerns regarding
their economic and environmental impact impede the transition to single-use duodenoscopes. This study investigated
the costs associated with two scenarios in which single-use
duodenoscopes are used in patients carrying multidrug-resistant microorganisms (MDROs).
Methods:
Break-even costs for single-use duodenoscopes
were calculated for two scenarios in which patients were
screened for MDRO carriage before undergoing endoscopic
retrograde cholangiopancreatography (ERCP). Only direct
costs related to the endoscopy were taken into consideration. In Scenario 1, patients were screened through microbiological culturing with a lag time in receiving the test result. In Scenario 2, screening was performed using GeneXpert analysis providing a rapid read-out. Calculations were
performed using data from a Dutch tertiary care center
and also with US healthcare data.
Results:
In the Dutch situation, single-use duodenoscopes
needed to be priced at a maximum of € 140 to € 250 to
break-even. In the US analyses, break-even costs varied
widely, depending on the duodenoscope-associated infection costs used, ERCP volume, and infection risk. The
break-even costs in Scenario 1 ranged between $78.21 and
$2,747.54 and in Scenario 2, between $248.89 and
$2,209.23.
Conclusions:
This study showed that a crossover scenario
in which single-use duodenoscopes are only used in patients carrying MDROs could be an economically viable alternative to a complete transition to single-use duodenoscopes. In the Dutch setting, single-use duodenoscopes
need to be priced much lower than in the United States to
reach a per-procedure cost that is comparable with a scenario using reusable duodenoscopes exclusively.
Single-use duodenoscopes
can prevent transmission of microorganisms through contaminated reusable duodenoscopes. Concerns regarding
their economic and environmental impact impede the transition to single-use duodenoscopes. This study investigated
the costs associated with two scenarios in which single-use
duodenoscopes are used in patients carrying multidrug-resistant microorganisms (MDROs).
Methods:
Break-even costs for single-use duodenoscopes
were calculated for two scenarios in which patients were
screened for MDRO carriage before undergoing endoscopic
retrograde cholangiopancreatography (ERCP). Only direct
costs related to the endoscopy were taken into consideration. In Scenario 1, patients were screened through microbiological culturing with a lag time in receiving the test result. In Scenario 2, screening was performed using GeneXpert analysis providing a rapid read-out. Calculations were
performed using data from a Dutch tertiary care center
and also with US healthcare data.
Results:
In the Dutch situation, single-use duodenoscopes
needed to be priced at a maximum of € 140 to € 250 to
break-even. In the US analyses, break-even costs varied
widely, depending on the duodenoscope-associated infection costs used, ERCP volume, and infection risk. The
break-even costs in Scenario 1 ranged between $78.21 and
$2,747.54 and in Scenario 2, between $248.89 and
$2,209.23.
Conclusions:
This study showed that a crossover scenario
in which single-use duodenoscopes are only used in patients carrying MDROs could be an economically viable alternative to a complete transition to single-use duodenoscopes. In the Dutch setting, single-use duodenoscopes
need to be priced much lower than in the United States to
reach a per-procedure cost that is comparable with a scenario using reusable duodenoscopes exclusively.
| Original language | English |
|---|---|
| Journal | Endoscopy International Open |
| DOIs | |
| Publication status | Published - 9 Jun 2023 |