Clinical outcomes and costs of reusable and single-use flexible ureterorenoscopes: a prospective cohort study

Abstract

The purpose of this study is to analyze clinical outcomes and costs of single-use flexible ureterorenoscopes in comparison with reusable flexible ureterorenoscopes in a tertiary referral center. Prospectively, 68 flexible ureterorenoscopies utilizing reusable (Flex-X2S, Flex-X, Karl Storz) and 68 applying single-use flexible ureterorenoscopes (LithoVue, Boston Scientific) were collected. Clinical outcome parameters such as overall success rate, complication rates according to Clavien-Dindo, operation time and radiation exposure time were measured. Cost analysis was based on purchase costs and recurrent costs for repair and reprocessing divided by number of procedures. In each group 68 procedures were available for evaluation. In 91% of reusable and 88% of single-use ureterorenoscopies stone disease was treated with a mean stone burden of 101 ± 226 and 90 ± 244 mm and lower pole involvement in 47 and 41%, respectively (p > 0.05). Comparing clinical outcomes of reusable vs. single-use instruments revealed no significant difference for overall success rates (81 vs. 87%), stone-free rates (82 vs. 85%), operation time (76.2 ± 46.8 vs. 76.8 ± 40.2 min), radiation exposure time (3.83 ± 3.15 vs. 3.93 ± 4.43 min) and complication rates (7 vs. 17%) (p > 0.05). A wide range of repair and purchase costs resulted in total to $1212-$1743 per procedure for reusable ureterorenoscopy whereas price of single-use ureterorenoscopy was $1300-$3180 per procedure. The current work provided evidence for equal clinical effectiveness of reusable and single-use flexible ureterorenoscopes. Partially overlapping ranges of costs for single-use and reusable scopes stress the importance to precisely know the expenses and caseload when negotiating purchase prices, repair prices and warranty conditions.

Single use versus reusable digital flexible ureteroscopes: A prospective comparative study

“…When the purchase cost was added to this, a cost of approximately $50 000 per 28 cases was calculated, resulting in a purchase cost of approximately $1500 per disposable fURS to be more economical than reusable fURS . A USA study of 655 fURS also showed similar costings . Our theoretical cost analysis has shown that disposable fURS are more economical for low‐volume centers, although the cost savings diminish over time as more cases are performed.…”

“…One study of 34 patients compared the LithoVue with the fiber‐optic URF‐P5/P6 (Olympus) and the digital Flex Xc (Storz, Tuttlingen, Germany), and showed that the LithoVue scored lower on most user comfort and maneuverability scores . Another study of 136 patients showed similar operative outcomes and complications between the Flex Xc/X2S and LithoVue …”

“…As our institution has a no‐fault institution‐wide contract for all endoscopes, it was not possible to calculate the exact cost incurred for each reusable fURS repair. A cost of $26 000 for each reusable fURS purchase and $10 000 per major repair was selected for our theoretical analysis, which is in line with the costs reported in other fURS cost analysis articles …”

“…A cost of $26 000 for each reusable fURS purchase and $10 000 per major repair was selected for our theoretical analysis, which is in line with the costs reported in other fURS cost analysis articles. 20 Data were analyzed using IBM SPSS Statistics for Windows, version 24.0 (IBM Corporation, Armonk, NY, USA). Normality tests were carried out on continuous variables.…”

“…19 Another study of 136 patients showed similar operative outcomes and complications between the Flex Xc/X2S and LithoVue. 20 The present study aimed to compare the operative performance of two single-use digital fURS with a reusable video fURS. We hypothesized that single-use fURS would have a similar performance to reusable fURS with a lower scope failure rate.…”