A COST-UTILITY ANALYSIS COMPARING THE TOTAL COST OF REUSABLE DUODENOSCOPES TO SINGLE-USE DUODENOSCOPES

Introduction: The COVID-19 pandemic is an unprecedent global medical emergency, causing an unforeseen tremendous burden on healthcare resources worldwide National and international gastrointestinal societies have strictly recommended that any endoscopic activity during the pandemic should be limited to emergency or non-deferrable procedures only Aims & Methods: To assess the impact of these mitigating measures applied during the COVID-19 pandemic on a busy tertiary referral endoscopy unit in London in terms of endoscopy activity, potential missed cancers and financial implications We also aimed evaluate the resultant effect of these measures based on their potential duration through projected, arbitrary cut-offs of a total of 5, 6 or 7 weeks, respectively The number of the endoscopy procedures cancelled and performed in our endoscopy unit during our 'delay phase' (16-22/03/2020) and 'lockdown phase' (23/03-03/04/2020) was reviewed and compared with endoscopy activity conducted during the same 3 weeks in 2019 The financial impact was subsequently analysed A projection of the impact on endoscopy activity caused by a potentially prolonged lockdown of 5, 6 and 7 weeks, respectively was estimated as well as the potential number of missed cancers Statistical examination was performed using Stata 16™ (StataCorp 2019, Stata Statistical Software: Release 16 College Station, StataCorp LLC, TX, USA) The financial implications of these cancellations on our endoscopic unit were estimated with reference to the 2019/2020 National Tariff Payment System, which is an official set of coded tariffs, established by the United Kingdom's National Health Service for care providers and commissioners Results: Between 16/03/2020 and 03/04/2020 a total of 479 procedures were cancelled and 130 non-deferrable procedures were performed In contrast, in 2019, 640 procedures were performed over the same timeframe, resulting in a revenue contraction of approximately £364,579 We estimated a potential backlog of 665-931 endoscopic procedures ac- cumulated over a period of 5-7 weeks of lockdown, requiring between 136-226 endoscopy lists after the 'lockdown phase', considering any potential delays to lists caused by safety precautionary measures Regarding the potential missed cancers, nine cancers were newly diagnosed from 23/03/2020 and 03/04/2020 This yielded a 55 6% (confidence intervals (CI) 21 2-86 3%) decrease in the rate of cancer diagnosis The projected number of potential missed cancers during lockdown would therefore be 11 (CI 4-17), 14 (CI 5-22) and 17 (CI 7-26) for the optimistic, realistic and pessimistic scenarios, respectively Conclusion: The results of our study highlight that even during the first 3 weeks of these essential restrictive measures;the COVID-19 pandemic has already had a considerable negative clinical and economic impact on our endoscopy service provision Furthermore, analysis of our projected figures shows that the impact of the COVID-19 pandemic may have even more severe repercussions on future hospital activity and economics, as we aim to recuperate any cancelled or postponed activity In addition, the potential, wide-ranging repercussions of delay in cancer care and other pathology is still not fully understood and studies to shed further light on this are required