Economic analysis of using the BD Single-Use Digital Flexible Ureteroscope in selective situations compared to universal use of a reusable flexible ureteroscope in the treatment of urolithiasis.
References Reset Defaults

Inputs

  • Hospital or organization name:
  • Number of flexible ureteroscopy cases performed in the past year:
  • Total amount spent on repairs of reusable flexible ureteroscopes in the past year:
  • Percentage of cases estimated to carry a high risk of ureteroscope damage. Alternatively, percentage of cases where the BD Single-Use Digital Flexible Ureteroscope will be used.

    24.6% of flexible ureteroscopy cases were found to meet the algorithm for using a single-use ureteroscope (years 2017 and 2018 at Hackensack University Medical Center - 154 of 626 total cases met the criteria).

    Algorithm Criteria:

    • large stone burden ( ≥ 1.5 cm )
    • multiple lower pole stones ( ≥ 3 )
    • extensive renal/ureteral tumor or laser use ( ≥ 1 hour )
    • bilateral ureteroscopy
    • stones within complex/tortuous renal anatomy

    Source: Munver R, et al. MP10-21. World Congress of Endourology. October 29-November 2, 2019.

  • Percentage of reusable ureteroscope repairs estimated to be associated with the high-risk cases:

    A number of papers have recommended selective use of single-use ureteroscopes to avoid scope damage:

    • For cases where the risk of reusable ureteroscope damage is high, the utilization of a single-use ureteroscope can be valuable. (Roberson 2020)
    • Urologists may wish to use single-use ureteroscopes for cases where reusable scope damage may occur. (Hennessey 2018)
    • A hybrid system combining single-use and reusable flexible ureteroscopes is probably the most advantageous for centers with a large operating volume. (Al-Balushi 2019)

    Other papers have quantified the damage associated with certain types of stones:

    • 97% of flexible ureteroscope damage involved exploration of the lower kidney pole. (Ozmiek 2017)
    • Staghorn stones resulted in damage in 33% of cases. (3 out of 9 cases, P=0.014)(Hennessey 2018)
    • Intraoperative scope failures were associated with larger stone burden/higher laser energy. (Higgins 2020)

  • Cost of the BD Single-Use Digital Flexible Ureteroscope:
  • Cost of the BD Image System, if applicable (in the analysis, this cost will be amortized over five years):

Single-Use Ureteroscope Economic Model

Selective Utilization Strategy to Minimize Repairs and Extend Service Life

Cost of the BD Single-Use Digital Flexible Ureteroscope (plus any ammortized per-case cost of the BD Image System):

Repair Cost/Case When Standardized on Reusable Ureteroscopes

  • Number of Flexible Ureteroscopy cases performed per year
  • Total dollars spent on reusable flexible ureteroscope repairs each year
This model estimates that 25% of flexible ureteroscopy cases are responsible for 75% of ureteroscope repairs.

Selective-Use Analysis - Single-Use Ureteroscopes Only Used for High-Risk-of-Scope-Damage Cases

  • Number of Low-Risk-of-Scope-Damage cases - those for reusable ureteroscopes - 75% of all cases
  • Number of High-Risk-of-Scope-Damage Cases - those for selective use with the BD device - 25% of all cases
  • Reusable ureteroscope repair costs avoided - estimated to be 75% of all repairs
  • BD Single-Use Digital Flexible Ureteroscope Cost (per year)
  • Estimated Incremental Cost Per Year
    (only considers repair costs and single-use ureteroscope costs)
    $0