Abstract
ABSTRACTPurpose to critically review all literature concerning the cost-effectiveness of flexible ureteroscopy comparing single-use with reusable scopes.Materials and Methods A systematic online literature review was performed in PubMed, Embase and Google Scholar databases. All factors potentially affecting surgical costs or clinical outcomes were considered. Prospective assessments, case control and case series studies were included.Results 741 studies were found. Of those, 18 were duplicated and 77 were not related to urology procedures. Of the remaining 646 studies, 59 were considered of relevance and selected for further analysis. Stone free and complication rates were similar between single-use and reusable scopes. Operative time was in average 20% shorter with digital scopes, single-use or not. Reusable digital scopes seem to last longer than optic ones, though scope longevity is very variable worldwide. New scopes usually last four times more than refurbished ones and single-use ureterorenoscopes have good resilience throughout long cases. Longer scope longevity is achieved with Cidex and if a dedicated nurse takes care of the sterilization process. The main surgical factors that negatively impact device longevity are lower pole pathologies, large stone burden and non-use of a ureteral access sheath. We have built a comprehensive financial cost-effective decision model to flexible ureteroscope acquisition.Conclusions The cost-effectiveness of a flexible ureteroscopy program is dependent of several aspects. We have developed a equation to allow a literature-based and adaptable decision model to every interested stakeholder. Disposable devices are already a reality and will progressively become the standard as manufacturing price falls.
Highlights
Flexible ureterorenoscopes are expensive to acquire and have limited longevity [1]
One must consider the costs of the laser machine used for stone fragmentation, personnel to take care of cleaning and sterilization processes, and all the disposable instruments used within the flexible ureteroscope procedure which have made it so efficient
These queries were designed to evaluate the clinical and economic impact of the type of flexible ureteroscope used on daily practice and are the following: 1) Are the stone free and complication rates different between single-use and reusable flexible ureteroscopes?
Summary
Flexible ureterorenoscopes are expensive to acquire and have limited longevity [1]. The significant improvements in flexible ureterorenoscopes have made flexible ureteroscopy the main treatment modality to target upper urinary pathologies, especially stone disease [2,3,4]. The low invasiveness of the procedure has made it popular worldwide. There is growing concern globally regarding its high costs [5]. One must consider the costs of the laser machine used for stone fragmentation, personnel to take care of cleaning and sterilization processes, and all the disposable instruments used within the flexible ureteroscope procedure which have made it so efficient. When a reusable scope breaks, some institutions may experience a significant delay for its replacement or repair, obligating to have more than one device so that the surgical program is not suddenly interrupted [3,4,5]
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