Relevance of Adopting a Hybrid Strategy Mixing Single-Use and Reusable Ureteroscopes for Stones Management: An Economic Study to Support the Best Strategy.

Fanny Monmousseau,Martine Le Verger,Sophie Dubnitskiy-Robin,Benjamin Pradère,Franck Bruyère,Julien Ramillon,Tanguy Le Fol,Solène Brunet-Houdard,Benjamin Faivre D’Arcier,Emmanuel Rusch

doi:10.3390/jcm10122593

Abstract

Endoscopic procedures such as ureteroscopy (URS) have seen a recent increase in single-use devices. Despite all the advantages provided by disposable ureteroscopes (sURSs), their cost effectiveness remains questionable, leading most teams to use a hybrid strategy combining reusable (rURS) and disposable devices. Our study aimed to create an economic model that estimated the cut-off value of rURS procedures needed to support the profitability of a hybrid strategy (HS) for ureteroscopy. We used a budget impact analysis (BIA) model that estimated the financial impact of an HS compared to 100% sURS use. The model included hospital volume, sterilization costs and the private or public status of the institution. Although the hybrid strategy generally remains the best economic and clinical option, a predictive BIA model is recommended for the decision-making. We found that the minimal optimal proportion of rURS procedures in an HS was mainly impacted by the activity volume and overall number of sterilization procedures. Private and public institutions must consider these variables and models in order to adapt their HS and remain profitable.

Highlights

Licensee MDPI, Basel, Switzerland.Single-use devices are rapidly developing in many medical specialties, including endourology [1]
Cut-off values are reported in Table 1 crossing the annual number of patients to be treated and the multiplying k-factor
Note: For example, for a public institution with 80 stone patients to be treated per year and a total number of 640 endoscope sterilization procedures per year, k is equal to 8 (k = 640/80)

Summary

Introduction

Single-use devices are rapidly developing in many medical specialties, including endourology [1]. Since 2015, single-use flexible ureteroscopes (sURSs) have been a major technological advancement in urolithiasis management. Their clinical performance and functional capabilities are comparable [2,3] to those of reusable ureteroscopes (rURSs). RURSs have disadvantages: they are fragile and prone to damage, and need to be reprocessed and maintained.

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Discussion

Conclusion