Sa1068 ECONOMIC BURDEN OF EMERGENT PRACTICES OF DUODENOSCOPES REPROCESSING AND SURVEILLANCE: BALANCING RISK- AND COST-CONTAINMENT

Abstract

Recent outbreaks of transmission of multi-drug resistant pathogens via contaminated duodenoscopes have led to the development of enhanced surveillance and reprocessing techniques (enhanced-SR) aimed at reducing and ultimately eliminating the transmission of pathogens by contaminated devices. The most commonly considered enhanced reprocessing methods include: double high-level disinfection (HLD), ethylene oxide (EtO) gas sterilization and culture-based monitoring of reprocessed scopes. Adoption of these methods may have significant economic impacts to the practice of ERCP. We aimed to assess the economic impact to an institution of adopting these strategies. We compared the expected costs of three enhanced reprocessing techniques versus single-HLD using data from two institutions that had implemented enhanced reprocessing techniques after experiencing an outbreak. 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 per-cycle. Changes in capital costs were compared to similar institutions without having yet adopted enhanced-SR. The economic impact attributable to enhanced-SR was defined as differences between total costs between single HLD and enhanced surveillance and reprocessing techniques. Compared to similar institutions not implementing these methods, enhanced-SR introduced significant scope down-time awaiting culturing results or EtO turn-around, and thus 3.4-times the number of scopes was needed per volume of procedures performed. Reprocessing costs increased up to 3.7-times with the introduction of enhanced-SR, from approximately $80 for single-HLD to more than $296 when using EtO. The adoption of repeat disinfection (for double HLD) increased total costs versus single-HLD approximately 46%. Whereas culturing and EtO increased total costs versus single-HLD 174% and 268%, respectively (Table 1). The total additional annual budget required to implement enhanced-SR was dependent on overall volume, but reached up to $406,000 in high volume centers (Table 2). Enhanced reprocessing techniques may reduce patient risk of exposure to contaminated duodenoscopes, but significantly increase the cost of performing ERCP. The significant costs associated with implementing enhanced-SR may impact patient access to ERCP in institutions unable to shoulder such a burden. These estimates do not include training costs required for, or intra-procedural degradations of efficiency that may be encountered due to of adoption of enhanced-SR and thus may be a conservative estimate of the total burden. Future innovation should focus on approaches that can ensure patient safety while maintaining patient access to ERCP by allowing it to be performed in a cost-effective manner.Table 1Cost-Comparison of scope reprocessing methods (per-cycle costs)Enhanced-SR ProtocolSingle HLDDouble HLDEthylene Oxide (EtO) Gas SterilizationScope Culturing-MonitoringCost CategoryReprocessing CostsStaff Labor$30.88$42.75$41.08$36.05Materials$49.59$74.83$51.28$74.83AER specific$4.50$9.00$4.50$9.00Non-AER$45.09$65.83$46.78$65.83EtO Gas Sterilization (3rd- Party)$204.13Culturing/Monitoring$109.82 Labor$100** Materials$9.82Total Reprocessing$80.47$117.58$296.49$220.70Notes: ** Dependent on scope volume, per-procedure costs based on 1,200 procedures per year; lower-volume centers would have higher costs in the amount of approximately $120,000/V, in which V is volume per year *** Assumes purchase of $40,000 scope depreciated over 5 years; 4.5 years for EtO scenario d.t. accelerated degradation. Lease scenario as $1,200 per scope per month. Open table in a new tab Table 2Financial Impact of Scope Efficiency and enhanced surveillance and reprocessingCategoryProcedures/Yr.Procedural Efficiency Pre-Enhanced-SR {Procedures / Scope / Year}Procedural Efficiency Post-Enhanced-SR {Procedures / Scope / Year}Additional Scopes Req’d (Addn’l Annual Budget)Enhanced-SR Additional Budget impact Per-procedure (annually)Total Budget Required d.t. Enhanced-SR (annually)High-volume1,2001564618.4 scopes ($147,160/yr)**$37.11-$216.02 ($44,532 / yr -$259,224 / yr)$191,692 -$406,384Medium volume2007823 estimated***6.1 scopes ($49,050/yr) **$37.11-$216.02 ($7,422 / yr -$43,204 / yr)$56,472– $92,254Notes: * Reported as a percentage of single-HLD costs ($80.47, Table1) ** Based on $40,000 per scope estimated list price and depreciated 5 years, service costs not considered and may thus be a conservative costing. *** Estimation based on ratio measured among high-volume. Open table in a new tab