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Low-temperature sterilization systems can generate high internal rates of return.Using low-temperature sterilization for steam-sterilizable endoscopes will save costs.Increased sterilization costs are outweighed by savings realized because of fewer repairs.Hydrogen peroxide–based, low-temperature sterilization has been shown to do less damage to medical instruments than steam autoclaves. However, low-temperature systems are more expensive to run. Higher costs need to be balanced against savings from reduced repair costs to determine value for money when choosing how to sterilize certain instruments, which are able to be reprocessed in either system.This analysis examines the economic effects of using low-temperature sterilization systems to reprocess rigid and semi-rigid endoscopes, which are sensitive to heat and moisture, but still able to be sterilized using steam. It examines the changes to costs and frequency of repairs expected over 10 years, resulting from a choice to sterilize these instruments in a low-temperature system instead of steam.Overall, the results showed that increased sterilization costs are outweighed by the savings associated with less frequent repairs. Over a 10-year period, in large health care facilities, the probability of achieving an internal rate of return of at least 6% is 0.81.Our model shows it is likely to be a good decision for large health care facilities to invest in low-temperature sterilization systems.