Single-use versus multiple-use accessories in gastrointestinal endoscopy: a systematic review of economic evaluations

In many countries, single-use endoscopy accessories such as forceps have almost replaced their reusable counterparts. We reviewed the evidence on the broader economic cost and environmental impacts associated with single-use and multiple-use accessories for gastrointestinal (GI) endoscopes.

Systematic review following the reporting guidelines of Preferred Reporting Items for Systematic Reviews and Meta-Analyses.

MEDLINE, Embase, Web of Science and Cochrane Database of Systematic Reviews were searched from 1 January 2000 to 25 September 2024.

We included published economic evaluations on single-use and reusable GI endoscope accessories which were written in English.

Two independent reviewers extracted data and quality-assessed identified studies according to the Consensus on Health Economic Criteria checklist.

Seven economic analyses were included: all were cost analyses. Three studies were from the USA, three from Europe and one from Korea. Patients in these studies underwent GI endoscopy (n=3), colonoscopy (n=2), gastroscopy (n=1) and endoscopic retrograde cholangiopancreatography (n=1). All studies compared single-use with reusable accessories, of which six were forceps. Reprocessing and purchase costs were included in all studies, repair costs were included in three studies, and environmental impact was only considered in one study. Most studies (n=5) reported a higher cost per procedure associated with single-use accessories.

Apart from two studies, all studies indicated that the cost per procedure was greater using single-use accessories/forceps. Future economic evaluations of single versus reusable accessories/forceps should include costs and also consequences of health and beyond, especially environmental impact.