Cut Costs, Drive Revenue
Physician, supply chain, and finance leaders often do not have a full picture of all the cost drivers associated with using reusable endoscopes. When all the benefits of single-use are considered — including streamlining operations, improving workflow and efficiency, and reducing cross contamination and patient infection risk —single-use is cost neutral or even saves money for many facilities.
History
Boost Productivity
Cut Costs
Patient Safety
Reduce Financial Risk
ESG
Repayment
Supply Chain
Why Single-Use Endoscopy is the Cost-Effective Solution
The cost of single-use is a major concern as hospitals, physicians, and other providers consider transitioning from reusable endoscopes.
On the surface, it is easy to assume that single-use will be more expensive than reusables. However, physician, supply chain, and finance leaders often do not have a full picture of all the cost drivers associated with using reusables.
For many facilities, single-use is cost neutral or even saves money. When all the benefits of single-use are considered — including streamlining operations, improving workflow and efficiency, and reducing cross contamination and patient infection risk — it is the cost-effective solution.
Cost Drivers in Endoscopy
There are four major cost drivers in endoscopy:
1) Capital equipment
2) Reprocessing
3) Repair and maintenance
4) Cross-contamination
Capital equipment includes the endoscopes, video towers, reprocessing equipment (e.g., automated endoscope reprocessors, or AERs, and sterilizers), drying cabinets, and other equipment used in the reprocessing cycle. Depending on the type, endoscopes may cost tens of thousands of dollars, and AERs and sterilizers can can add thousands more in expenses. These capital investments then sit on the corporate balance sheet as depreciating assets.
Reprocessing is highly complex and operationally burdensome, with more than 100 individual steps.6 Regardless of the method of reprocessing — manual soaking, high-level disinfection, or sterilization — significant amounts of consumable supplies are used for each cycle. For example, one HLD cycle requires on average two full sets of personal protective equipment (PPE). Reprocessing is also resource-intensive from a staffing perspective, and those labor costs must be considered.
Repair and maintenance of endoscopes and reprocessing equipment are unavoidable costs. Whether through repair and maintenance contracts or ad-hoc repairs, these costs tend to increase over time as equipment undergoes more wear and tear.
Finally, cross-contamination of endoscopes due to improper reprocessing, and the resulting costs of treating patient infections that result, must also be considered as a cost-driver. Even when guidelines are adhered to, reprocessing still carries risks — many experts believe there is no way to completely eliminate the risk of cross-contamination. Studies show that infection rates are approximately 2.8 percent for patients after bronchoscopies and range from 1 percent to 2.5 percent for patients after duodenoscopies, depending on the chosen reprocessing method.[i],5 While not a direct cost to a facility or provider, they are costs to the health system overall.
There are other cost drivers beyond these four categories that must be considered, as well. These include training reprocessing staff, implementing compliance programs, and transporting scopes to and from central reprocessing.
Opacity and Your Bottom Line
Many of the cost drivers in reusable endoscopy lack cost transparency. With so many steps involved in reprocessing, it is difficult to track every individual cost to assess how much is spent overall to reprocess endoscopes.
These costs may come out of multiple departmental budgets and may be tied up in multiple contracts with multiple vendors. Additionally, repair and maintenance contracts can be opaque — it can be difficult to know whether the cost of the contracts is fair and related to the risk of equipment failure.
Fixed vs. Variable Costs
Reusable endoscopes expose facilities to financial risk. First, most of the costs associated with reusables are largely fixed: depreciating capital investments, reprocessing operations, and repair contracts. These costs are not variable with the ups and downs of patient volumes, and this is especially concerning during the COVID-19 pandemic.
This can create scenarios where revenue drops but costs do not decline accordingly. Single-use costs, by contrast, vary with procedure volume, resulting in predictable margins. Single-use endoscopes are considered supplies, and as a result they do not depreciate and stay on a balance sheet for years like reusables.
Secondly, the risk of an outbreak related to endoscope contamination is not just a patient safety concern — it’s also a big financial risk due to the impact on institutional reputation . Outbreaks have gained media attention multiple times in recent years, and the negative coverage can have an immeasurable brand impact and drive patients to other hospitals and providers.
Cost Comparison Videos
The True Cost of Reusable Duodenoscopes
Reusable vs Single-Use Rhinolaryngoscopes: Comparing the Costs and Performance
Comparing Reusable and Single-Use
How do the costs of reusables and single-use endoscopes compare? Several studies have calculated the cost of reusables, so we compiled the following table to summarize the research on the per-use cost of reusables and compare that total cost to the cost of a single-use endoscope:
| Reusable Cost Per Use | ||||||||||
|---|---|---|---|---|---|---|---|---|---|---|
| Capital Equipment | Repairs | Reprocessing | Cross Contamination | Total | Single-Use Cost | |||||
| Duodenscopes2-4 | $679 | $182 | $80-406 | $472 | $1413-1739 | $1695-1995 | ||||
| Bronchoscopes5,6 | $126 | $99 | $191 | $330 | $656 | $275-300 | ||||
| Cystoscopes7,8 | $51 | $54 | $104 | n/a | $210 | $175-225 | ||||
| ENT Scopes9 | $50 | $161 | $27 | n/a | $238 | $165-195 | ||||
Productivity Gains and Pleased Patients
In addition to lowering costs, switching to single-use may also drive workflow improvements. The ability to remove a single-use scope from the pack, plug it in, and immediately begin using it — as well as faster clean up and room turnover post-procedure — may allow for more procedures to be conducted each day.
The ability to use single-use endoscopes in more spaces in the facility can also result in productivity gains.
In addition, single-use addresses scope availability issues that can occur with reusables. Situations arise where there are no reprocessed scopes available, due to reprocessing delays, or scopes being out for repairs, or particularly busy days with large numbers of procedures. The result? Additional costs and delayed revenue, not to mention inconveniences for patients and physicians.
Let’s Run the Numbers
The per-use cost of reusables varies significantly across different facilities, depending on procedure volume, price paid for capital, how often scopes need repairs, the type of reprocessing used, and many other factors.
That’s why it’s important to do a custom analysis to see the true reusable costs in your facility. Then you’ll be able to accurately compare that to the cost of single-use and make an informed decision.
Ambu’s health economics department provides customized health economic impact reports free of charge to any interested facility. The team can also estimate your potential for productivity gains, and resulting revenue increases, from switching to single-use.
With a few data points from you, they will run an analysis that will provide a customized report.
To request an analysis and report, email us-healthecon@ambu.com or visit our online calculators at singleuseendoscopy.com.
References:
1 Barakat et al. “Cost Utility Analysis Comparing Duodenoscope [RM1] Reprocessing/Sterilization, Novel Duodenoscopes with Disposable Endcaps and Fully Disposable Duodenoscopes.” Digestive Disease Week, May 2020
2 Travis, et al, 2020. The total cost of reusable duodenoscopes – Are single-use duodenoscopes the future of ERCP? Pharmacoeconomics: Open Access 5:1
4 Muthusamy, et al, 2018. Sa1068 Economic Burden of Emergent Practices of Duodenoscope Reprocessing and Surveillance: Balancing Risk and Cost-Containment. Gastrointerstinal Endoscopy 87:6S.
5 Mouritsen, et al, 2020. A systematic review and cost effectiveness analysis of reusable vs. single-use bronchoscopes. Anaesthesia 75:529-40.
6 Ofstead, et al. 2017. A glimpse at the true cost of reprocessing endoscopes: Results of a pilot project. In International Journal of Healthcare Central Service Material Management. Available at https://www.bostonscientific.com/content/ dam/bostonscientific/uro-wh/portfolio-group/LithoVue/pdfs/Sterilization-Resource-Handout.pdf.
7 Taguchi K, et al. Micro-Costing Analysis Demonstrates Comparable Costs for LithoVue Compared to Reusable Flexible Fiberoptic Ureteroscopes. Journal of Endourology 2018(32)
8 Ambu-collected data from 32 hospitals and clinics conducting cystoscopies.
9 Walczak R, et al. Reusable vs disposable nasopharyngolaryngoscopes: Cost analysis and resident survey. Laryngoscope Investigative Otolaryngology 2020;1-6.
New Study: Single-Use Bronchoscopes Can Cut Hospital Readmissions by 53%
Hospitals that perform bronchoscopies can reduce readmission rates by over half, and potentially lower costs, by adopting single-use flexible bronchoscopes. That’s according to a new abstract that was submitted and presented at the recently completed CHEST 2021 Annual Meeting.
Cost Calculators
To calculate the costs savings on moving from reusable to single-use endoscopes, take advantage of our cost calculators for Bronchoscopes, Cystoscopes, and Duodenoscopes.
