Cost-effectiveness analysis of single-use duodenoscope applied to endoscopic retrograde cholangiopancreatography

Abstract

Secondary infections due to transmission via the duodenoscope have been reported in up to 3% of endoscopic retrograde cholangiopancreatographies. The use of single-use duodenoscopes has been suggested. We investigate the cost-effectiveness of these duodenoscopes use in cholangiopancreatography. Methods: A costeffectiveness analysis was implemented to compare the performance of cholangiopancreatographies with reusable duodenoscopes versus single-use duodenoscopes. Effectiveness was analysed by calculating quality-adjusted life years (QALY) from the perspective of the National Health System. Possibility of crossover from single-use to reusable duodenoscopes was considered. A willingness-to-pay of 25,000 euro/QALY was set, the incremental cost-effectiveness ratio (ICER) was calculated, and deterministic and probabilistic sensitivity analyses were performed. Results: Considering cholangiopancreatographies with single-use and reusable duodenoscopes at a cost of 2,900 and 1,333 euro, respectively, and a 10% rate of single-use duodenoscopes, ICER was greater than 3,000,000 euro/QALY. A lower single-use duodenoscope cost of 1,211 euro resulted in an ICER of 23,583 euro/QALY. When the unit cost of the single-use duodenoscope was 1,211 euro, a crossover rate of more than 9.5% made the use of the single-use duodenoscope inefficient. Conclusions: Singleuse duodenoscopes are cost-effective in a proportion of cholangiopancreatographies if its cost is reduced. Increased crossover rate makes single-use duodenoscope use not cost-effective.