Single-use duodenoscopes have the potential to reduce per-procedure costs for endoscopic retrograde cholangiopancreatography (ERCP) at various endoscopy centers, according to a new multicenter micro-costing study published in Pharmacoeconomics.

This is particularly true for low-volume centers where few procedures drive up the per-procedure cost. That’s because the investment in capital equipment is distributed over a lower volume, which increases the per-procedure cost.

At endoscopy centers with fewer than 50 ERCP patients annually, per-procedure costs range from $2,591.39 to $2,685.76, according to the study. The study’s authors estimate single-use duodenoscopes will cost between $1,400 and $3,000 depending on the manufacturer. That means the disposable technology likely will be a cost-effective option for reducing the risk of duodenoscope-associated infection at various endoscopy centers.

The health economics journal Pharmacoeconomics published “The Total Cost of Reusable Duodenoscopes – Are Single-Use Duodenoscopes the Future of ERCP?” in June 2020.

Helena Strømstad Travis, Lars Holger Ehlers and Jacqueline Thornton authored the study. Travis was a student when conducting the study, but became an Ambu employee in June 2020. Ambu develops and manufactures single-use endoscopes and will launch a single-use duodenoscope in 2020.

The cost per procedure for large-volume centers (more than 350 procedures annually) is between $1,110.29 to $1,338.78, according to the study. For low-volume centers with fewer than 350 annual ERCPs, the cost per procedure rose to between $1,220.58 and $2,685.76.

Average costs per procedure were based on data from seven endoscopy centers in Orlando, Florida. The estimated per-procedure cost included the costs for equipment (duodenoscopes and automated endoscope reprocessors) as well as reprocessing, personnel, and duodenoscope maintenance and repair.

The authors also included the estimated costs for treating duodenoscope-related infection resulting from cross-contamination. The duodenoscope-related infection risk ranged between 1 percent and 1.2 percent, according to the study. The infection risks were similar to the estimates presented in a 2019 Gut study by Ji Young Bang, Bryce Sutton, Robert Hawes, and Shyan Varadarujulu.

The FDA has recommended since 2018 that endoscopy centers culture duodenoscopes as an extra measure to reduce cross-contamination risk. The authors, however, did not include the cost of culturing in their analysis – an estimated $220 per procedure.

An estimated $1,400 to $3,000 price point makes single-use duodenoscopes a potentially cost-effective solution for reducing the risk of infection during ERCP. The performance of single-use technology will need to rise to the challenge of the procedure’s complexity, the authors conclude.

Duodenoscope reprocessing has been under increased scrutiny in recent years as media reports of patient infections have highlighted the challenges in cleaning these complex instruments. Duodenoscopes have an elevator mechanism on the distal tip that harbors potentially dangerous organisms if not properly cleaned.

Mulitdrug-resistant infections have also been traced back to inadequately reprocessed duodenoscopes.

The FDA has issued recommendations for mitigating the risk of patient cross-contamination. They include using endoscopes with disposable endcaps, using disposable duodenoscopes, reprocessing with double high-level disinfection, or sterilizing the instruments between uses.

For more information

Ambu single-use bronchoscopes have been on the market since 2009. The company will launch a single-use duodenoscope in 2020 and has plans to release a single-use colonoscope and gastroscope in 2021 and 2022, respectively.

To learn more about Ambu’s future in gastroenterology, visit