Are single-use duodenoscopes a cost-effective alternative to their reusable counterparts? Economic evaluation...

Endoscopy units are increasingly being encouraged to consider replacing multiple-use (MU) endoscopes with single-use (SU) endoscopes, largely because of a reduction in cross-infection. Although evidence suggests comparable technical performance, SU and MU endoscopes are associated with different costs and environmental impacts. Wider adoption of SU endoscopes should be informed by a comprehensive analysis of their costs, effectiveness, and environmental impacts. This study aims to compare SU versus MU duodenoscopes (fully reusable or partially reusable with disposable caps [MU or MUDC]) used in gastroenterology, in terms of costs and effectiveness.

A cost-utility analysis was performed using a decision analytic model comparing SU, MU, and MUDC endoscopes. Key parameters included the cost of procedures associated with each device, as well as the costs and health effects (in quality-adjusted life years [QALYs]) associated with infections. The base-case analysis was conducted from the perspective of United Kingdom National Health Service, with additional analyses considering alternative estimates and environmental impacts associated with the use of SU, MU, and MUDC endoscopes.

On the basis of the best available evidence on cross-contamination rates and probability of infection after exposure to contaminated devices, our analyses showed that SU endoscopes were substantially more costly and negligibly more effective than MU and MUDC endoscopes, leading to excessive incremental cost-effectiveness ratios above £200,000 per QALY. Accounting for colonization, extended time horizons, variations in key parameters, willingness-to-pay thresholds, or monetized environmental impact did not alter the overall findings.

Our analysis shows that SU duodenoscopes are not a cost-effective option compared with MU alternatives.