THERAPEUTIC ERCP - A COST-PROHIBITIVE PROCEDURE

Background: ERCP is increasingly being performed for therapeutic purpo ses and engenders a proliferation of disposable equipment without a cl ear indication of cost-effectiveness. Methods: We analyzed the financi al impact of ERCP by prospectively analyzing ERCPs performed in our in stitution from June 1, 1994, to September 30, 1994, by calculating cha rges related to indirect costs, disposable equipment costs, and overal l reimbursement. The data were analyzed according to insurance payor a s well. Results: Disposable equipment costs a mean of $149 per diagnos tic ERCP and $532 per therapeutic ERCP. For diagnostic ERCP, disposabl e equipment accounted for 27% of reimbursement; for therapeutic ERCP, disposable equipment accounted for 68% of reimbursement. Although over all reimbursement was higher for therapeutic ERCP, the very high direc t costs related to disposable equipment limited the ability of reimbur sement to cover indirect costs. Conclusions: Depending on the complexi ty of cases, quantity of disposable equipment used, and patient-insura nce mix, therapeutic ERCP may be cost prohibitive for a given endoscop y unit. Indirect costs should be more carefully and quantitatively ana lyzed. Disposable equipment should be evaluated in terms of cost, safe ty, and patient outcome.