Concept of disposable duodenoscope: at what cost?

Although most postendoscopic retrograde cholangiopancreatography (ERCP) biliary tract infections are attributed to suboptimal ductal drainage, transmission of infection by contaminated reusable duodenoscopes has been reported. To overcome this limitation, a disposable duodenoscope has been recently developed. However, given the widespread use and large volume of ERCPs being performed worldwide, the financial viability of this novel concept is unclear. Utilising an activity-based costing and financial model, we estimated that the per-procedure cost of a disposable duodenoscope in the United States can vary from $797 to $1547 for centres performing at the 75th percentile of ERCP procedure volume and from $1318 to $2068 for centres performing at the 25th percentile of procedure volume, based on infection rates of 0.4% to 1%, respectively. However, when infection was not factored, the per-procedure cost decreased to $818 and $297 for centres performing at the 25th and 75th percentiles, respectively. Given the recent reports on infection outbreaks, including carbapenem-resistant Enterobacteriaceae (CRE), caused by contaminated duodenoscopes used at ERCP,1–4 a disposable duodenoscope (ExaltTM, Single-Use Duodenoscope, Boston Scientific Corporation, Natick, Massachusetts, USA) has been developed to circumvent this problem.5 To determine the adaptability of this innovation in clinical practice, we estimated the per-procedure cost of ERCP using a reusable duodenoscope in order to assess the break-even costs for transitioning to disposable duodenoscopes. An activity-based costing and financial model was constructed based on the current clinical practice of ERCP at a tertiary medical centre in the USA. The annual procedure volume was 1752 ERCPs in 2018. Nine duodenoscopes with lifetime usage of 3 years and a reprocessing turn-over time of 40 min per scope were required to meet the clinical needs. The cost of an individual duodenoscope was $35 000 ($11 667/year) with annual maintenance and repair costs of $1451 per scope. The annual cost …