Abstract
Background and study aims The costs of reusable endoscope reprocessing have been evaluated, yet external validity
of the findings remains challenging. The aim of this study was to assess the costs
of purchase, maintenance, microbiological control, and reprocessing of a reusable
duodenoscope per endoscopic retrograde cholangiopancreatography (ERCP) in France.
Study findings exclude the costs of infection, downtime due to breakdown, reprocessing
single-use material disposal, and device disposal, all of which should also be considered.
Materials and methods The study encompassed both observational and theoretical approaches. Observational
data were collected in four hospitals, from December 2019 to December 2020, with an
ad hoc survey, based on 2016 and 2018 national guidelines for duodenoscope reprocessing.
Costs were modeled, using the same guidelines, assuming a mean workload of 223 ERCP/duodenoscope/year.
Results The mean observed cost of purchase, maintenance, microbiological control, reprocessing
(human resources and consumables), and overhead (additional 35%) with a reusable duodenoscope
was €80.23 (standard deviation €3.77) per ERCP. The corresponding mean theoretical
cost was €182.71 for manual reprocessing without endoscope drying cabinet (EDC), €191.36
for manual reprocessing with EDC, €235.25 for automated endoscope reprocessing (AER)
without EDC, and €253.62 for AER with EDC.
Conclusions Because procedures, equipment, volume activity, number of duodenoscopes, human resources,
and internal work organizations are hospital-dependent, observed costs varied between
hospitals. Theoretical costs were higher than observed costs, showing that the theoretical
approach is not sufficient. Hypotheses to explain the difference between the two approaches
include failing to measure some costs in the survey and challenges in guideline implementation.
Keywords
Cholangioscopy - Pancreatoscopy - Quality and logistical aspects - Hygiene - Pancreatobiliary
(ERCP/PTCD) - Quality and logistical aspects
