By Allison Mascarenhas
Vizient Category Manager
It can be tricky for clinicians and supply chain leaders to determine whether (and in what cases) to select reusable or single-use endoscopes as both devices have their benefits and drawbacks.
Reusable endoscopes, for example, boast a successful track record when it comes to high-quality images and advanced functionality with integrated technology, and when fully sterilized, they are safe for patients. The demand for disposable endoscopes is driven by reduced costs in maintenance, cleaning and sterilization, and storage; however, clinicians often note they do not offer the same image quality and functionality as their reusable counterparts.
When clinicians and supply chain leaders are evaluating single-use and reusable endoscopes, here are some factors to consider:
1. Clinical Impact
For advanced diagnostic and therapeutic procedures, reusable endoscopes may be preferred due to maneuverability, higher image quality, sturdiness, handling, suction power and ease of medical record integration. In addition, reusable endoscopes are often preferred because of their adequate insertion channel sizes for easier passage of instruments and tools.
Of course, when it comes to reducing infection, single-use endoscopes have the advantage as they are always sterile, minimizing the risk of cross contamination or infection in patients and staff. In response, several manufacturers of reusable endoscopes have designed new components for the devices, such as disposable end caps that can be removed from the duodenoscope to eliminate the need for reprocessing and ultimately reduce disease transmission.
Single-use endoscopes can be stored locally at the point of use, providing timely access during urgent situations, and they are considered more effective with anesthesia and when performing routine diagnostic procedures. In addition, single-use endoscopes are portable and easy to access, eliminating the need for endoscopy staff to move and set up the tower cart and enabling difficult entryway into the body. However, based on physician preference surveys, single-use endoscopes do not offer the image quality, maneuverability, ease of tool insertion and ease of reach for the suction button as reusable endoscopes.
2. Environmental Impact
There are environmental factors that should be considered for both reusable and single-use endoscopes. The cleaning and reprocessing of reusable endoscopes require a significant amount of personal protective equipment (PPE) and chemicals and detergents. Studies have shown that using one set of protective wear per operation and the materials for cleaning and disinfection of reusable endoscopes have comparable or higher material and energy consumption, as well as higher emissions of CO2 equivalents and values of resource consumption.
Single-use endoscopes are composed of hard-to-recycle plastics, making it problematic to find suitable recycling solutions. However, medical device companies that produce single-use endoscopes are seeking opportunities to partner with waste management companies in an effort to reduce their environmental footprint and in some cases convert the waste to energy.
In terms of carbon footprint, studies show that per single use, the CO2 equivalent and embodied energy of disposable endoscopes is about half that of reusable. In practice, this trend reverses when usage over the lifecycle of a reusable endoscope is considered with disposable endoscopes generating greater annual CO2 tonnage than reusable.
3. Financial Impact
Reusable endoscopes require high levels of disinfection and reprocessing, which can increase hospital expenses. In addition, hospitals must consider the costs associated with the maintenance and repair of reusable endoscopes.
Over the lifespan of reusable scopes, repair costs may surpass the initial cost of the device, which can be significant when considering overall operative costs. Reusable endoscopes may be sent out for repair multiple times throughout the year due to human errors made during procedures — such as dropping the endoscope — or wear and tear over time, thus leading to additional downtime. Reusable endoscopes also require more hospital staff available in the operating room for preparation of the endoscopy tower and instruments utilized during procedures.
Dependent on procedural volume, single-use endoscopes are typically more cost effective than reusable since they do not require disinfection and there are no maintenance costs associated with these devices, which removes any downtime related to repairs.
In addition, the Centers for Medicare and Medicaid Services (CMS) recently approved a transitional pass-through (TPT) payment by creating a new category and new HCPCS C-codes specific for single-use duodenoscopes and ureteroscopes. Hospitals should consider this reimbursement when reviewing capital budget and purchases and evaluating economic benefits and efficiency.
4. Operational Impact
Value analysis is an important aspect of any product adoption. As such, when looking at purchasing a single-use vs. a reusable endoscopes, hospitals must:
- Identify key stakeholders in sourcing, as well as a clinical project champion such as a nurse or physician, a value analysis professional and/or a sustainability leader.
- Determine the department and end users that will be impacted.
- Determine timeline for staff education and trial of product.
Single-use endoscopes are still relatively new to the market and clinicians and their partners in supply chain should compare the clinical, environmental, financial and operational impacts with those offered during the lifespan of reusable endoscopes when making decisions.
About the author
Allison Mascarenhas is a portfolio executive on Vizient’s capital, imaging and asset management team. Allison has more than eight years of experience in medical supply chain operations, health insurance and managed care administration. Her educational background includes a Bachelor of Science in biological sciences from Louisiana State University, a Master of Public Health with a concentration in health policy and systems management from Louisiana State University Health Sciences Center, and a Master of Business Administration from University of New Orleans.