Category: Clinical Stones: Ureteroscopy
Introduction & Objective :
Flexible ureteroscopes are fragile instruments that can be expensive to operate, but are vital to management of urolithiasis. Because of the repair costs involved, a single-use ureteroscope has been developed for these procedures. We analyzed the cost of ownership of our flexible ureteroscope fleet across 21 hospitals over a 1.8 year period.
We analyzed the cost of acquisition of the flexible ureteroscope and video tower system, repair expenses, and cleaning costs for all ureteroscopies done by 110 urologists at 21 hospitals encompassing Kaiser Permanente Northern California. Our fleet of ureteroscopes include Olympus URF-P6 and URF-V2, Storz FlexX, and Wolfe Cobra ureteroscopes.
Ureteroscopes were reprocessed using Sterrad NX ® per manufacturer recommendations. All sterile processing department personnel underwent proper training and certification.
All repairs were done by a third party vendor per manufacturer guidelines. Reasons for repair included failure of a leak point test, damage to the deflecting mechanism, or poor optics.
From January 2015 through October 2016, 4,685 flexible ureteroscopies were performed and 186 ureteroscopes were used for the procedures. Between 13 to 502 ureteroscopies were performed at each hospital and each hospital had between 1 to 20 ureteroscopes.
The cost of initial purchase of the video tower system was $52,000 and the median pricing of the flexible ureteroscope was $15,750. Total capital equipment cost for this period was $4,021,500 and capital equipment cost per use was $858.38.
Costs analysis for processing included the cost for decontamination, assembly, and sterilization of the scope. Supply and labor costs for each step were $18.35, $3.74, $12.91, respectively. The total cost to reprocess was $163,928 or $34.99 per scope use.
Repair costs per center ranged from $0 to $33,859 and totaled $124,527 for the entire system. Per use, the average repair cost was $26.58.
In total, the cost of ureteroscopy was $919.95 per use. Amongst all the hospitals, the cost per use ranged from $393.77 (for a high volume center with low repair costs) to $9936.57 (for a low volume center with high repair costs).
The single-use ureteroscope has been developed as a means for offsetting the high cost of flexible ureteroscopy, and it costs $1500 per use. For those hospitals with higher volumes, it may not be cost effective. Assuming a hospital has 5 ureteroscopes with a life span of 1.8 years and all capital equipment needs purchasing, then compared to the single-use ureteroscope, standard flexible ureteroscopy is a cost advantage if at least 91 ureteroscopies are performed.