Table 1.
Base-case probability and utility estimates.
| Variable | Base-case estimate (range tested in Monte Carlo analysis) |
|---|---|
| Clinical probabilities, % | |
| Pretest probability of CRE-infected endoscope* | 1 (0–10) |
| CRE transmission after ERCP with infected endoscope(6, 7, 14) | 31 (10–50) |
| Patient with CRE develops clinical symptoms(7, 14) | 73 (25–100) |
| CRE-related mortality(7, 13, 16, 19, 20) | 43 (10–75) |
| Proportion of initial admissions complicated by cholangitis requiring PTC tube placement(18)† | 23 (10–50) |
| ERCP minor complication(1) | 5.2 (1–10) |
| ERCP major complication(1) | 1.7 (1–7) |
| ERCP-related mortality(1) | 0.3 (0–2) |
| LC minor complication(34) | 5.6 (1–10) |
| LC major complication(34) | 4.1 (1–10) |
| LC-related mortality(34) | 0.1 (0–2) |
| LC/CBDE minor complication(35) | 14 (9–19) |
| LC/CBDE major complication(35) | 8.2 (3–13) |
| LC/CBDE-related mortality(36) | 0.5 (0–2) |
| FDA-recommended duodenoscope reprocessing strategy, % | |
| Effectiveness at eliminating CRE* | 90 (50–100) |
| Culture and hold strategy, % | |
| Sensitivity of duodenoscope culture for CRE* | 85 (50–95) |
| Duodenoscope with CRE-positive culture after one HLD(13) | 3.0 (1–10) |
| Duodenoscope with CRE-positive culture after two HLD* | 1.5 (1–10) |
| EtO sterilization strategy, % | |
| Effectiveness at eliminating CRE* | 99 (90–100) |
| Halt ERCP, perform LC with CBDE strategy, % | |
| CRE transmission with LC with CBDE strategy | 0 (0–0) |
| Utility estimates | |
| CRE-related sepsis(37) | 0.50 (0.40–0.60) |
| Post CRE-sepsis survival(37) | 0.80 (0.70–0.90) |
| ERCP without complication(38) | 0.89 (0.79–0.95) |
| ERCP minor complication(38) | 0.88 (0.78–0.95) |
| ERCP major complication(38) | 0.76 (0.66–0.86) |
| LC +/− CBDE without complication(39) | 0.90 (0.80–0.95) |
| LC +/− CBDE minor complication(39) | 0.80 (0.70–0.90) |
| LC +/− CBDE major complication(40) | 0.61 (0.51–0.71) |
CBDE = common bile duct exploration; CRE = carbapenem-resistant Enterobacteriaceae; ERCP = endoscopic retrograde cholangiopancreatography; EtO = ethylene oxide; HLD = high-level disinfection; FDA = Food and Drug Administration; LC = laparoscopic cholecystectomy; PTC = percutaneous transhepatic cholangiography.
*
No data supporting base-case estimate. The estimate is an assumption.
†
Only applicable for “halt ERCP, perform LC/CBDE” strategy.