Abstract

BACKGROUND: Transmission of multi-drug resistant organisms by duodenoscopes during ERCP is problematical. The FDA recently recommended transitioning away from reusable fixed endcap duodenoscopes to those with innovative device designs that make reprocessing easier, more effective, or unnecessary. Partially disposable duodenoscopes with disposable endcap (PD) and fully disposable duodenoscopes (FD) are now available. We assess the relative cost of approaches to minimizing infection transmission, taking into account duodenoscope-transmitted infection cost.METHODS: We developed a Monte Carlo analysis model in R with a multi-state trial framework to assess the cost-utility of various approaches: (1) Single HLD, (2) Double HLD, (3) Ethylene oxide (EtO) sterilization, (4) Culture & hold, (5) PD and (6) FD. We simulated quality adjusted life years (QALY) lost by duodenoscope-transmitted infection and factored this into the average cost for each approach.RESULTS: At infection transmission rates <1%, PD was most favorable from a cost utility standpoint in our base model. The FD minimizes the potential for infection transmission and is more favorable from a cost utility standpoint than use of reprocessable duodenoscopes after single/double HLD at all infection rates, more favorable from a cost utility standpoint than EtO for infection rates >0.32%, and culture & hold for infection rates >0.56%. Accounting for alternate scenarios of variation in hospital volume, QALY value, post-ERCP lifespan and environmental cost shifted cost utility profiles.CONCLUSIONS: Our model indicates that PD represent the option most favorable from a cost utility standpoint for ERCP, with anticipated very low infection transmission rate and a low-cost disposable element. These data underscore the importance of cost calculations which account for the potential for infection transmission and associated patient morbidity/mortality.

View details for DOI 10.1016/j.gie.2022.01.002

View details for PubMedID 35026281