Cost comparison of oral, transnasal and magnet assisted capsule endoscopy in the examination of the upper gastrointestinal tract in patients with dyspepsia

IntroductionConventional oral upper gastrointestinal (GI) endoscopy can obe uncomfortable. By comparison, transnasal endoscopy (TNE) and magnet assisted capsule endoscopy (MACE) have superior tolerability. A cost comparison of competing upper GI endoscopic modalities have yet to be performed. MethodsWe performed a cost comparison study of oral, TNE and MACE by a combination of activity-based costing and averaging of fixed costs over 24 481 upper GI endoscopies performed for dyspepsia over a 10-year period. ResultsOn average, 9.4 procedures were performed daily. TNE was cheapest at euro125.90 per procedure, costing 30% less than oral endoscopy at euro184.10 and threefold cheaper than MACE at euro407.10. Flexible endoscope reprocessing cost euro53.80. TNE was cheaper than oral endoscopy as sedation was not required. Oral endoscopies have a further rate of infectious complications, estimated to cost euro16.20 per oral procedure in inpatient admissions. Oral and TNE equipment are more expensive to purchase and maintain than MACE costing euro79 330 and euro81 819, respectively compared with MACE at euro15 420 per annum. However, capsule endoscopes cost significantly more per procedure at euro369.00 than the consumables for flexible endoscopy (per oral euro12.30, TNE euro5.30). ConclusionsTNE cost less to perform than conventional per oral endoscopy. The cost of capsule endoscopes will need to be reduced significantly if routine use is to be expected.