Safety-cost trade-offs in medical device reuse: a Markov decision process model

Abstract

Healthcare expenditures in the US are approaching 2 trillion dollars, and hospitals and other healthcare providers are under tremendous pressure to rein in costs. One cost-saving approach which is gaining popularity is the reuse of medical devices which were designed only for a single use. Device makers decry this practice as unsanitary and unsafe, but a growing number of third-party firms are willing to sterilize, refurbish, and/or remanufacture devices and resell them to hospitals at a fraction of the original price. Is this practice safe? Is reliance on single-use devices sustainable? A Markov decision process (MDP) model is formulated to study the trade-offs involved in these decisions. Several key parameters are examined: device costs, device failure probabilities, and failure penalty cost. For each of these parameters, expressions are developed which identify the indifference point between using new and reprocessed devices. The results can be used to inform the debate on the economic, ethical, legal, and environmental dimensions of this complex issue.

Reprocessing of Single-Use Medical Devices: Clinical and Financial Results

“…With regard to the economic analysis indicators, there is a huge difference between the cost of acquiring a new SUMD and a reprocessed device, and this difference in the case of the Harmonic ACE® scissors and the linear suture machine GIA Covidien TM comprises a saving around 50% per device, confirming the results obtained in international studies [15, 16, 23, 24]. This practice allowed for a yearly saving of EUR 90,556.16 just for the 2 devices.…”

Towards design strategies for circular medical products

“…That is, whether it is more financially viable to recover the product or to discard and replace it. This trade-off is recognised in existing literature of the circular economy strategy (Cong et al, 2017), however, Sloane (2007) points out that in the medical world a cost-benefit analysis of recovery must also take into account the costs potentially inherent in the clinical risks of device reuse. In the case of refurbishment or remanufacture of high-value, high-complexity devices, this balance already seems to tip in favour of recovery, considering the large and growing refurbishment/remanufacturing industry.…”

“…Though these devices are by and large not designed to be reused, and policy does not require them to be so, their high cost of production compared to cost of recovery leads many hospitals to regard recovery as the most financially viable option. The costbenefit model created by Sloane (2007) suggests that there are some items which will always remain disposable, since the cost of their recovery will always be greater than the cost of the device itself. For these products, recovery at the level of material (recycling) may be the only viable option, and thus should be the strategy which designers should optimise for.…”

Critical Issues in Reprocessing Single-Use Medical Devices for Interventional Cardiology

“…Anyway, market dynamics forces to make stable the ratio between new catheter prices and regenerated device's cost, usually placed in the range of 0.4-0.5 by third party reprocessor. Finally, quotes for patient's insurance and risk management should be introduced in the model, and more complex cost-effective analyses and decisional processes have to be applied in case reprocessed device is not as safe and effective as the new one (Sloan, 2007). …”