Table 3.
Results of 1-way sensitivity analyses.
| Variable | Base-case estimate |
Threshold | Comment |
|---|---|---|---|
| Pretest probability of CRE, % | 1 | 24 | If probability exceeds this threshold, then culture and hold becomes the most cost-effective strategy |
| Probability of patient CRE transmission from a CRE-infected duodenoscope, % | 31 | – | FDA-recommended reprocessing is the most cost-effective strategy across the tested range (0% to 100%) |
| Probability patient with CRE develops clinical symptoms, % | 73 | – | FDA-recommended reprocessing is the most cost-effective strategy across the tested range (0% to 100%) |
| Probability patient with CRE dies, % | 43 | – | FDA-recommended reprocessing is the most cost-effective strategy across the tested range (0% to 100%) |
| Effectiveness of FDA-recommended reprocessing at eliminating CRE, % | 90 | – | FDA-recommended reprocessing is the most cost-effective strategy across the tested range (0% to 100%) |
| Sensitivity of duodenoscope culture for CRE, % | 85 | – | FDA-recommended reprocessing is the most cost-effective strategy across the tested range (0% to 100%) |
| Effectiveness of EtO sterilization at eliminating CRE, % | 99 | – | FDA-recommended reprocessing is the most cost-effective strategy across the tested range (0% to 100%) |
| Probability endoscope damaged by EtO, requiring replacement, % | 1 | – | FDA-recommended reprocessing is the most cost-effective strategy across the tested range (0% to 100%) |
| Cost culture and hold*, $ | 400 | 82 | If cost is below this threshold, then culture and hold is the most cost-effective strategy |
| Cost EtO reprocessing†, $ | 1044 | 84 | If cost is below this threshold, then EtO reprocessing is the most cost-effective strategy |
CRE = carbapenem-resistant Enterobacteriaceae; EtO = ethylene oxide; FDA = Food and Drug Administration.
*
Includes cost of new duodenoscopes, FDA-recommended reprocessing, cultures, EtO sterilization on duodenoscopes with two successive positive cultures, and cost of replacing duodenoscopes damaged by EtO.
†
Includes cost of new duodenoscopes, FDA-recommended reprocessing, EtO sterilization, and cost of replacing duodenoscopes damaged by EtO.