Category: Epidemiology, Health Policy, Socioeconomics & Outcomes
Introduction & Objective :
Clinical data suggest an equipoise between single-use (disposable) and reusable flexible ureterorenoscope (fURS) in terms of scope characteristics, manipulation, view and clinical outcomes.The procedural cost of reusable fURS is dependent on the initial and repair cost, maintenance and scope sterilisation and on the number of procedures performed/repair. We conducted a systematic review on the procedural cost ($) of fURS based on the individual authors reported data on the number of procedures performed before repair and to see if it is a feasible option compared to single use fURS.
A systematic review carried out in a Cochrane style and in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) checklist using Medline, Scopus, CINAHL, EMBASE and Cochrane library for all English language articles. All papers on fURS cost analysis were searched from 2000-2018 (19 years), which mentioned the cost of fURS based on the number of procedures performed and the repairs needed (procedure/repair) as reported by the individual authors.
Six studies reported on both the number of procedures performed with number of repairs needed and the cost calculated/procedure in the given time period. The number of uses/repair in various studies varied between 8-29 procedures and the cost per procedure varied between $120-$1212/procedure (Table 1). A significant trend was observed between the decreasing cost of repair with the number of usage (Fig 1). With studies reporting on a minimum of 20 cases/repair the mean cost was around $200/procedure. This is contrast to the disposable scopes such as Lithovue ($1500-$2000/usage) and Pusen ($700/usage).
The cost of reusable fURS is low in centres performing a high volume of procedures. Similarly, when a reasonable volume of procedures (>15) are performed before scope repair, the cost is significantly lower than the disposable scopes. This review proves that reusable fURS are still more cost effective than disposable scopes with some studies suggesting cost as low as 10% of the cost of disposable scopes.
Michele Talso– Consultant Urologist, ASST Vimercate Hospital, Italy, milano, Lombardia, Italy
Ioannis Goumas– Consultant Urologist, ASST Vimercate Hospital, Italy, Vimercate, Lombardia, Italy
Guido Kamphuis– Consultant Urologist, AMC Hospital Amsterdam, Amsterdam, Noord-Holland, Netherlands
Laurian Dragos– Consultant Urologist, University of Medicine and Pharmacy Victor Babes, Timisoara, Romania, Timisoara, Timis, Romania
Tzevat Tefik– Associate Professor of Urology, Istanbul University Istanbul Faculty of Medicine, Istanbul, Istanbul, Turkey
Bhaskar Somani– Consultant Urologist, Associate Professor, University Hospital Southampton , U.K, Southampton, England, United Kingdom
ASST Vimercate Hospital, Italy
milano, Lombardia, Italy
MD Urologist Consultant
ASST Vimercate Hospital MB
ASST Vimercate Hospital, Italy
Vimercate, Lombardia, Italy
AMC Hospital Amsterdam
Amsterdam, Noord-Holland, Netherlands
University of Medicine and Pharmacy Victor Babes, Timisoara, Romania
Timisoara, Timis, Romania
Associate Professor of Urology
Istanbul University Istanbul Faculty of Medicine
Istanbul, Istanbul, Turkey
Tzevat Tefik studied Medicine at Istanbul University, Cerrahpaşa Faculty of Medicine, English Department (1997-2004) and then he finished his Urology training (2005-2011) at Istanbul University, Istanbul Faculty of Medicine. He did a short fellowship in Tenon Hospital (2015) with Professor Olivier Traxer.
Tzevat has published more than 35 peer-reviewed articles and over 140 published abstracts/presentations in National/International meetings. These cover a broad range of topics in Endourology, Renal Transplantation, Oncology, Laparoscopy and Paediatric Urology.
Consultant Urologist, Associate Professor
University Hospital Southampton , U.K
Southampton, England, United Kingdom
Bhaskar is an Endourologist and Associate Professor in Southampton, and is an active member of European School of Urology 'Training and Research group' and ESUT Endourology group. He has been teaching on EUREP hands-on-training for the last 5 years and is the senior author in the new ‘Endoscopic stone treatment (EST)’ curriculum established for training and examinations. He has performed live surgery in EAU with presentations and moderations in EULIS, WCE and SIU. He is also a member of EAU ‘Train the Trainer’ committee.
He is research active and has published more than 200 papers with over 300 published abstracts/presentations. He is on the editorial board of 3 journals, a reviewer for 14 journals and Investigator for 5 trials. He sits on the MCQ panel for FRCS examinations and is a ‘Specialist advisor’ to National Institute of Clinical Excellence (NICE) Interventional procedures and ‘Invited expert’ to NICE urological infections. He is an elected member of BAUS Academic section and was recently selected as a Fellow of Faculty of Surgical Trainers.