Abstract
Background and study aims Recent outbreaks attributed to contaminated duodenoscopes have led to the development
of enhanced surveillance and reprocessing techniques (enhanced-SRT) aimed at minimizing
cross-contamination. Common enhanced-SRT include double high-level disinfection (HLD),
ethylene oxide (EtO) gas sterilization, and culture-based monitoring of reprocessed
scopes. Adoption of these methods adds to the operational costs and we aimed to assess
its economic impact to an institution.
Methods We compared the estimated costs of three enhanced-SRT versus single-HLD using data
from two institutions. We examined the cost of capital measured as scope inventory
and frequency of scope use per unit time, the constituent reprocessing costs required
on a per-cycle basis, and labor & staffing needs. The economic impact attributable
to enhanced-SRT was defined as the difference between the total cost of enhanced-SRT
and single HLD.
Results Compared to single HLD, adoption of double HLD increased the costs approximately
by 47 % ($80 vs $118). Similarly, culture and quarantine and EtO sterilization increased
costs by 160 % and 270 %, respectively ($80 vs $208 and $296). Enhanced-SRT introduced
significant scope downtime due to prolonged techniques, necessitating a 3.4-fold increase
in the number of scopes needed to maintain procedural volume. The additional annual
budget required to implement enhanced-SRT approached $406,000 per year in high-volume
centers.
Conclusions While enhanced-SRT may reduce patient risk of exposure to contaminated duodenoscopes,
it significantly increases the cost of performing ERCP. Future innovation should focus
on approaches that can ensure patient safety while maintaining the ability to perform
ERCP in a cost-effective manner.
