تجزیه و تحلیل هزینه به حداقل رساندن فورسپس جامبو قابل استفاده مجدد در مقابل فورسپس یکبار مصرف در مرکز آندوسکوپی سرپایی با حجم بالا

Background Endoscopists worldwide are faced with the challenge of choosing the most cost-effective and durable equipment. There are limited data comparing the 2 major options for endoscopic forceps: disposable and reusable. Disposable forceps are marketed as the cost-effective alternative to reusable forceps. Objective This study was designed to provide a prospective assessment of the survival and cost of reusable versus disposable forceps to allow more educated decisions when purchasing endoscopic equipment. Design A 24-month prospective study in a high-volume ambulatory endoscopy center (AEC) with 71 Olympus jumbo reusable forceps (OJRF). A “cost of OJRF per procedure” was generated to compare to the estimated cost of disposable forceps per procedure. Setting Gastrointestinal Associates PA of Jackson, Mississippi, which performs approximately 24,000 outpatient procedures per year. Patients General patient population of this AEC undergoing colonoscopy. Main Outcome Measurements Mean cost of forceps per procedure and survival of reusable forceps. Cost was derived from purchase price, cleaning costs, repair/maintenance costs, and number of uses. Results Over the 24-month period, the total cost per procedure was $3.27. The mean number of uses per OJRF was 166.3. Sixty-eight percent of the forceps required no repair throughout the 2-year study, and only 1 forceps was deemed beyond repair. For comparison, disposable forceps were assigned a cost per procedure of $10.00 on the basis of conservative market price. Over a 2-year period this cost-per-procedure difference resulted in a cost savings of $79,482 Limitations Failure to determine the average life-span of OJRF because 98% were still functioning properly after 2 years and an average of 166.3 procedures. Evaluation did not include storage and disposal costs, which would add a miniscule additional cost to disposable costs. The study also does not address some of the other arguments for disposables such as performance (quality of specimen) compared with reusables. The estimated average number of uses and durability was only studied for the OJRF. Other forceps may have different average cost per use and durability. Conclusions In a large-volume AEC, OJRF are vastly more durable than resusable forceps reported in prior studies and are vastly more cost-effective than disposable forceps. A longer study period would have only revealed more dramatic cost savings and durability.

Our data clearly indicate that OJRFs are extremely durable and much more cost saving than are disposable forceps. These data will serve as a valuable tool for endoscopy centers to make educated decisions when purchasing biopsy forceps. In today's health care environment, cost-efficiency is a chief concern for all physicians and must be balanced with instrument performance and patient safety. Therefore, cost, patient safety, and instrument performance are the key elements to examine when comparing disposable versus reusable forceps.8 and 9 Proponents of single-use disposable products market convenience, variety of products, consistent performance, lack of cleaning costs, and low risk of cross-contamination as reasons to use disposable instruments.3, 5 and 6 In contrast, advocates of reusable equipment negatively note the costs incurred in the purchase, storage, and disposal of single-use disposable equipment.5, 8 and 10 Furthermore, environmental issues are also a concern with disposable medical instruments because they occupy landfill space or require polluting incineration.11 and 12 We suggest that reusable biopsy forceps are not only more cost saving than disposable forceps but are also extremely durable and do not compromise patient safety when proper reprocessing procedures are followed. Although our study did not systematically assess for evidence of infectious complications, prior reports of cross-contamination have been related to lapses in recommended infection control practices.13 The limitations of this study include use of a “conservative estimate of disposable pricing” versus a cost-to-cost comparison with disposable forceps. Although there was no known instance of cross-contamination, infection, or other complications, the study was not specifically designed with a formal cross-contamination evaluation. The major strengths of this study include the large number of forceps and procedures evaluated and the careful measurements of reprocessing and repair costs. Similar studies comparing reusable and disposable forceps are limited by vastly fewer biopsy sessions. Our purchase price of $276.25 was noted to be lower than in previous studies, where purchase prices ranged from $326.00 to $455.00.14 and 15 The machinery acquisition and reprocessing cost of $1.41 per procedure was substantially less than in multiple prior studies, with costs ranging from $3.25 to $16.56.8, 9 and 14 Two on-site devices, the Ritter M11 UltraClave Automatic Sterilizer and the Bransonic Model 8510MT Ultrasonic Tabletop Cleaner, were used to reprocess forceps. A 10-year life expectancy was estimated for each of the 2 devices; neither required maintenance repair during the study. Our results are based on estimates of various parameters, including the life expectancy of this equipment and reprocessing time. These estimates were biased in favor of disposable forceps (ie, likely overestimate the cost of reuse). Overall, the reusable forceps proved to be much more durable than previously reported in the literature. Of the 71 OJRFs, only 32% (23/71) required repairs (including shipping) totaling $2,396.25, as shown in Table 3. Only 1 of these required multiple repairs (see forceps 3, Table 3), and only 1 was deemed irreparable, as shown in Table 4. Repair costs added $0.20 to each of the 11,810 procedures, which is much less than the previously reported repair cost of $1.20 per forceps use.8 The mean number of uses before repair (for the 32% that malfunctioned) was 64 with a range of 4 to 190. In contrast, a previous study reported a rapid decline, with as many as 80% of forceps malfunctioning after 20 uses, whereas some showed durability up to 91 uses.9 and 16 However, these prior studies were limited to a very small number of approximately 100 biopsy sessions compared with the 11,810 monitored in our study. Given that the reprocessing and repair costs from this study are much lower than from previous studies, even if the cost of reprocessing and repair was as high as previously reported ($3.25) in one study, the cost per procedure would only increase to $5.11. This significant savings is due to the durability—166 average uses per OJRF. Even if the reprocessing costs of our study were tripled to $3.87 per case, the overall cost per case would be $5.85, substantially less than our predicted disposable cost of $10.00. One possible reason this study showed a greater durability compared with prior studies is secondary to the emphasis placed on education of the staff to exercise caution in handling and transportation of the equipment. The massive number of procedures and the mean number of uses per forceps proved to be the most notable difference in our study compared with previous studies. The total number of uses for all 71 OJRFs during the 24-month period was 11,810. This produced a mean number of uses per forceps of 166.3, with a range from 16 to 230. In one previous study, only 22% (26/119 forceps) were ever used more than 20 times.8 Our data confirm that OJRF forceps are capable of achieving a much greater number of uses than previously believed. Note that only 1 forceps was used to the point of being irreparable. Cost per procedure would continue to decrease if all 71 OJRFs were followed until deemed irreparable. The value of these data is to show the total cost per procedure difference between reusable and disposable forceps to allow endoscopists to make educated decisions when purchasing equipment. Our study concludes that reusable forceps are not only more durable than previously reported, but they are also vastly more cost-effective than their disposable counterparts. Similar studies of the wide range of reusable devices available would assist endocopists in developing policies for cost containment.