Cost Comparison of Reusable Vs Single Use Flexible Ureteroscopes

WisCope Single Use Digital Flexible Ureteroscope

From our conversations with Medical Specialists in South Africa, we discovered they are facing some challenges in the daily practice of endourology, namely the lack of reliable ureteroscopes. Conventional reusable ureteroscopes have proven unreliable because they are highly priced, damaged easily and expensive to repair or replace.

They also require skilled personnel to clean and sterilize. The most common methods of sterilisation for heat sensitive surgical endoscopes include soaking in Cidex (ortho-phtalatealdehyde) or glutaraldehyde. Both substances are harmful irritants to the respiratory system[1] and their use is banned in many European countries.

To solve these limitations, single use ureteroscopes were developed over 10 years ago. Today disposable ureteroscopes perform just as well, if not better than their reusable counterparts in terms of manoeuvrability, quality of vision, and efficacy, and do not require re-sterilisation.

But hospitals and Medical Aid Schemes in South Africa have been slow in adopting new technology, largely due to the perceived cost.

Let’s dive deeper and compare the costs.

A recent review by Ventimiglia, E., Godínez, A. J., Traxer, O., & Somani, B. K. [2] shows the cost comparison of single use versus reusable flexible ureteroscopes. According to the authors, there is a large variation of acquisition costs as well as the average number of times a reusable ureteroscope can be used before requiring repair or replacement. Factors influencing the occurrence of breakage include the number of surgeons who have access to the scope and the degree of training of the personnel involved in the use or reprocessing of the scopes.

In this article, we will assume that there is an initial cost of R250 000 to buy a reusable ureteroscope. If the hospital were to use the scope 21 times before it needed to be replaced, the cost per procedure would be R11 905, but if the same scope was used only 6 times, the cost per procedure skyrockets to R41 666.

In addition to the acquisition costs of reusable ureteroscopes (not mentioning the need of having more than one), hospitals also need to consider the maintenance costs, breakages, and reprocessing which are expenses that add up when determining the cost per procedure. Expenses which we haven’t included in our example above.  

Additional factors to consider are effectiveness of reusable scopes, which diminishes with each case in terms of picture quality and resolution.[3]

Compared to the cost of a single use ureteroscope at R14 000 per procedure. If the hospital had 21 cases, then the hospital pays R294 000 (which is only 15% more compared to the cost of reusable ureteroscopes in our example) and if the hospital had 6 cases to do, then the hospital pays R84 000 (which is 66% less than reusable ureteroscopes in our example) 

This simple example shows that the price of single use ureteroscopes is compatible and even more cost effective when it comes to lower-case loads.

And there would be no additional costs incurred for single use ureteroscopes such as training staff on how to properly reprocess scopes, no repair costs, and no re-sterilisation with harmful substances.  

In addition, single use ureteroscopes offer several advantages over reusable ureteroscopes as follows:

• Perform extremely well, with an image resolution of 400 x 400 pixels, thus the image as good as the best reusable scope

• High-end image quality, equipped with CMOS sensors

• Maximal deflection of 275 Degrees backward and forward  

• Lightweight and reduce surgeon fatigue

• Small distal diameter which includes a working channel

• Bright LED light arrangement for good vision of the operating field 

• It is cost effective

Ureteroscopes are considered hospital equipment and come with a hefty price tag, which hospitals are willing to pay, if it means Medical Specialists can perform surgical procedures and improve quality of life. But as anything else, hospital equipment needs to be maintained, repaired, or replaced when it breaks and resterilised between procedures. And herein lies an opportunity for hospitals and Medical Aid Schemes in South Africa to pivot and move on to better, more cost effective and reliable technology.

If you require more information on Single Use Flexible Ureteroscopes or where to buy contact Wismed on 031 206 0177 or email orders@wismed.co.za

[1] Catlin, N. R., Willson, C. J., Stout, M., Kissling, G. E., Waidyanatha, S., Baker, G. L., Hayden, B. K., & Wyde, M. (2017). Evaluation of the respiratory tract toxicity of ortho-phthalaldehyde, a proposed alternative for the chemical disinfectant glutaraldehyde. Inhalation toxicology, 29(9), 414–427. https://doi.org/10.1080/08958378.2017.139001

[2] Ventimiglia, E., Godínez, A. J., Traxer, O., & Somani, B. K. (2020). Cost comparison of single-use versus reusable flexible ureteroscope: A systematic review. Turkish journal of urology, 46(Supp. 1), S40–S45. https://doi.org/10.5152/tud.2020.20223

[3] Ventimiglia, E., Godínez, A. J., Traxer, O., & Somani, B. K. (2020). Cost comparison of single-use versus reusable flexible ureteroscope: A systematic review. Turkish journal of urology, 46(Supp. 1), S40–S45. https://doi.org/10.5152/tud.2020.20223