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CC BY-NC-ND 4.0 · Endosc Int Open 2023; 11(06): E571-E580
DOI: 10.1055/a-2064-9721
Original article

Single-use duodenoscopes compared with reusable duodenoscopes in patients carrying multidrug-resistant microorganisms: a break-even cost analysis

Judith A. Kwakman 
1   Department of Gastroenterology and Hepatology, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
2   Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
,
Marten J. Poley
3   Institute for Medical Technology Assessment (iMTA) & Erasmus School of Health Policy & Management (ESHPM), Erasmus University Rotterdam, The Netherlands
4   Department of Pediatric Surgery and Intensive Care, Sophia Children’s Hospital, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
,
Margreet C. Vos‡
2   Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
,
Marco J. Bruno‡
1   Department of Gastroenterology and Hepatology, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
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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.



Publication History

Received: 11 October 2022

Accepted after revision: 21 March 2023

Article published online:
09 June 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Rubin ZA, Murthy RK. Outbreaks associated with duodenoscopes: new challenges and controversies. Curr Opin Infect Dis 2016; 29: 407-414
    CrossrefPubMedGoogle Scholar
  • 2 Balan GG, Sfarti CV, Chiriac SA. et al. Duodenoscope-associated infections: a review. Eur J Clin Microbiol Infect Dis 2019; 38: 2205-2213
    Google Scholar
  • 3 Kwakman JA, Erler NS, Vos MC. et al. Risk evaluation of duodenoscope-associated infections in the Netherlands calls for a heightened awareness of device-related infections: a systematic review. Endoscopy 2021; 54: 148-155
    PubMedGoogle Scholar
  • 4 Larsen S, Russell RV, Ockert LK. et al. Rate and impact of duodenoscope contamination: A systematic review and meta-analysis. EClinicalMedicine 2020; 25: 100451
    Google Scholar
  • 5 Gromski MA, Sieber MS, Sherman S. et al. Double high-level disinfection versus liquid chemical sterilization for reprocessing of duodenoscopes used for ERCP: a prospective, randomized study. Gastrointest Endosc 2020; 93: 927-931
    CrossrefPubMedGoogle Scholar
  • 6 Snyder GM, Wright SB, Smithey A. et al. Randomized comparison of 3 high-level disinfection and sterilization procedures for duodenoscopes. Gastroenterology 2017; 153: 1018-1025
    Google Scholar
  • 7 U.S. Food and Drug Administration. The FDA is Recommending Transition to Duodenoscopes with Innovative Designs to Enhance Safety: FDA Safety Communication. https://www.fda.gov/medical-devices/safety-communications/fda-recommending-transition-duodenoscopes-innovative-designs-enhance-safety-fda-safety-communication
    PubMedGoogle Scholar
  • 8 Gromski MA, Sherman S. Technological review: developments in innovative duodenoscopes. Gastrointest Endosc 2022; 95: 42-50
    CrossrefPubMedGoogle Scholar
  • 9 Chan BPH, Berzin TM. The endoscopy patient as a vector and victim. Gastrointest Endosc Clin N Am 2020; 30: 745-762
    CrossrefPubMedGoogle Scholar
  • 10 Peter S, Bang JY, Varadarajulu S. Single-use duodenoscopes: where are we and where are we going?. Curr Opin Gastroenterol 2021; 37: 416-420
    CrossrefPubMedGoogle Scholar
  • 11 Kovaleva J. Infectious complications in gastrointestinal endoscopy and their prevention. Best Pract Res Clin Gastroenterol 2016; 30: 689-704
    CrossrefPubMedGoogle Scholar
  • 12 Bang JY, Sutton B, Hawes R. et al. Concept of disposable duodenoscope: at what cost?. Gut 2019; 68: 1915-1917
    CrossrefPubMedGoogle Scholar
  • 13 Travis HSE, Holger L, Thornton J. The total cost of reuseable duodenoscopes – are single-use duodenoscopes the future of ERCP. Pharmacoeconomics 2020; 5: 1-3
    CrossrefPubMedGoogle Scholar
  • 14 van der Schoor AS, Voorin 't holt AF, Severin JA. et al. Value of nontargeted screening for highly resistant microorganisms: The MOVE study. Infect Control Hosp Epidemiol 2020; 41: s429-s430
    CrossrefPubMedGoogle Scholar
  • 15 Muthusamy VR, Ross AS. Sa1068 economic burden of emergent practices of duodenoscopes reprocessing and surveillance: Balancing risk- and cost-containment. Gastrointest Endosc 2018; 87: AB167-AB168
    CrossrefPubMedGoogle Scholar
  • 16 Agency for Healthcare Research and Quality. Healthcare Cost and Utilization Project (HCUPnet). https://datatools.ahrq.gov/hcupnet
    PubMedGoogle Scholar
  • 17 Chen LF, Knelson LP, Gergen MF. et al. A prospective study of transmission of Multidrug-Resistant Organisms (MDROs) between environmental sites and hospitalized patients-the TransFER study. Infect Control Hosp Epidemiol 2019; 40: 47-52
    CrossrefPubMedGoogle Scholar
  • 18 Tickler IA, Dela Cruz CM, Obradovich AE. et al. Presence of Clostridioides difficile and multidrug-resistant healthcare-associated pathogens in stool specimens from hospitalized patients in the USA. J Hosp Infect 2020; 106: 179-185
    CrossrefPubMedGoogle Scholar
  • 19 Bang JY, Hawes R, Varadarajulu S. Equivalent performance of single-use and reusable duodenoscopes in a randomised trial. Gut 2020; DOI: 10.1136/gutjnl-2020-321836.
    CrossrefPubMedGoogle Scholar
  • 20 Muthusamy VR, Bruno MJ, Kozarek RA. et al. Clinical evaluation of a single-use duodenoscope for endoscopic retrograde cholangiopancreatography. Clin Gastroenterol Hepatol 2019; 18: 2108-2117.e3
    CrossrefPubMedGoogle Scholar
  • 21 Ross AS, Bruno MJ, Kozarek RA. et al. Novel single-use duodenoscope compared with 3 models of reusable duodenoscopes for ERCP: a randomized bench-model comparison. Gastrointest Endosc 2019; 91: 396-403
    CrossrefPubMedGoogle Scholar
  • 22 Napoléon B, Gonzalez JM, Grandval P. et al. Evaluation of the performances of a single-use duodenoscope: Prospective multi-center national study. Dig Endosc 2022; 34: 215-221
    Google Scholar
  • 23 Mouritsen JM, Ehlers L, Kovaleva J. et al. A systematic review and cost effectiveness analysis of reusable vs. single-use flexible bronchoscopes. Anaesthesia 2020; 75: 529-540
    CrossrefPubMedGoogle Scholar
  • 24 Lim D. Boston Scientific gets 1st US disposable duodenoscope clearance. MedTech Dive. https://www.medtechdive.com/news/boston-scientific-fda-first-disposable-duodenoscope-clearance/569144/
    PubMedGoogle Scholar
  • 25 Barakat MT, Ghosh S, Banerjee S. Cost utility analysis of strategies for minimizing risk of duodenoscope related infections. Gastrointest Endosc 2022; 95: 929-938.e2
    CrossrefPubMedGoogle Scholar
  • 26 Cassini A, Hogberg LD, Plachouras D. et al. Attributable deaths and disability-adjusted life-years caused by infections with antibiotic-resistant bacteria in the EU and the European Economic Area in 2015: a population-level modelling analysis. Lancet Infect Dis 2019; 19: 56-66
    CrossrefPubMedGoogle Scholar
  • 27 van Dulm E, Tholen ATR, Pettersson A. et al. High prevalence of multidrug resistant Enterobacteriaceae among residents of long term care facilities in Amsterdam, the Netherlands. PLoS One 2019; 14: e0222200
    CrossrefPubMedGoogle Scholar
  • 28 Deb A, Perisetti A, Goyal H. et al. Gastrointestinal endoscopy-associated infections: update on an emerging issue. Dig Dis Sci 2022; 67: 1718-1732
    CrossrefPubMedGoogle Scholar
  • 29 Rodríguez-Villodres Á, Martín-Gandul C, Peñalva G. et al. Prevalence and risk factors for multidrug-resistant organisms colonization in long-term care facilities around the world: a review. Antibiotics (Basel) 2021; 10: 680
    CrossrefPubMedGoogle Scholar
  • 30 Namburar S, von Renteln D, Damianos J. et al. Estimating the environmental impact of disposable endoscopic equipment and endoscopes. Gut 2021; 71: 1326-1331
    CrossrefPubMedGoogle Scholar
  • 31 Agrawal D, Tang Z. Sustainability of single-use endoscopes. Techniq Innovations Gastrointest Endosc 2021; 23: 353-362
    CrossrefPubMedGoogle Scholar
  • 32 ARUP Laboratories. Healthcare's climate footprint. 2019 https://www.arup.com/perspectives/publications/research/section/healthcaresclimate-footprint
    PubMedGoogle Scholar