HPB P21 A Systematic review and Narrative Synthesis of Health Economic Evaluation of single use duodenoscopes

Abstract

Abstract Background Multidrug-resistant infections transmitted through duodenoscopes in ERCP procedures have raised significant concerns. In response, the U.S. Food and Drug Administration (FDA) has suggested shifting from traditional reusable duodenoscopes to newer, more innovative designs. These new models, including completely disposable duodenoscopes and those with disposable endcaps, aim to enhance cleaning efficiency and reduce infection risks. While sterile, single-use duodenoscopes have been a breakthrough in eliminating cross-infections, their adoption poses cost-related challenges. Methods We conducted a systematic literature search across various databases for studies that examined the cost-effectiveness of these two types of duodenoscopes. Four studies met our inclusion criteria, involving diverse settings and study designs, including cost-effectiveness, cost-utility, and cost-minimization analyses. Results All four studies suggested that single use duodenoscopes could be cost-effective compared to reusable ones under certain circumstances, such as specific infection rates, procedure volumes, and willingness to pay thresholds. However, limitations in the generalizability of findings were noted, and the quality of evidence varied across studies. Conclusions Current evidence indicates potential cost-effectiveness for single-use duodenoscopes, although it is context-dependent. More robust, high-quality studies are needed to confirm these findings and further explore the cost-effectiveness in various clinical settings and scenarios. The potential environmental impact of single use duodenoscopes warrants further exploration.