The total cost of reuseable duodenoscopes - are single-use duodenoscopes the future of ERCP?

Multiple outbreaks have been reported due to contaminated patient-ready duodenoscopes used for endoscopic retrograde cholangiopancreatography (ERCP). These outbreaks have forced the Food & Drug Administration (FDA) to issue Safety Communications recommending healthcare facilities to transition to duodenoscopes with newer designs minimizing the risk of contamination and patient-to-patient infections. Sterile single-use duodenoscopes eliminates the risk of contamination and subsequent cross-infections and no reprocessing or repair is needed. This multicentre study found, the cost per ERCP including capital investments, repair/maintenance, reprocessing, and post-endoscopic infection ranges from $1,110.29 to $1,338.78 at high volume centres (>350 ERCPs/year) and from $1,220.58 to $2,685.76 at low-volume (<350 ERCP/year) centres using 1% and 1.2% infection rates, respectively. The weighted average per-procedure cost based on the annual number of ERCP procedures ranges between $1,283.93 and $1,378.29 using 1% and 1.2% infection rates, respectively. Costs were estimated using a micro-costing approach. Single-use duodenoscopes might be cost-effective at most facilities due to the risk of infection and costs associated with reprocessing and maintaining reusable duodenoscopes.