Department of Urology, Ghent University Hospital, Ghent, Belgium.
Department of Urology, University Hospitals Leuven, Leuven, Belgium.
J Endourol. 2021 Oct;35(10):1454-1459. doi: 10.1089/end.2021.0006. Epub 2021 May 19.
To determine which flexible ureterorenoscopy program would be most cost-efficient in our center, a cost efficiency analysis and a formula to assess cost efficiency feasibility of a hybrid model were performed. Total cost per case of reusable flexible ureterorenoscopes (rfURS) was retrospectively calculated and compared with two single-use flexible ureterorenoscopes (sufURS) marketed. A mathematical formula was developed from our data to identify the necessary increase of use of rfURS (NIU-rfURS) to be cost-efficient in a hybrid system utilizing sufURS for only high-risk-of-breakage cases. In 57 months, 983 procedures were performed using 4 digital rfURS (Flex-XC; Storz), necessitating 45 repairs, with a total repair cost of €256.809. Including the capital investment of €24.000 per scope and €60 per sterilization cycle, the cost per case averaged €419 after 983 cases. Consistently using sufURS would have cost 55% to 127% more (respectively, Uscope PU3022 and Lithovue at €650 and €950 manufacturer suggested retail price). On a per case analysis, the cost was initially extremely high, but declined to reach a plateau around €480 after ∼400 cases. After 155 or 274 procedures, a rfURS program appeared more cost-efficient than consistently using Lithovue or Uscope PU3022, respectively. Based on our data and formula, if we would hypothetically use Uscope PU3022 or Lithovue for 15% of the cases, the NIU-rfURS is, respectively, 28% or 74% (∼6 or 16 cases). The NIU-rfURS increases exponentially with an increased use of sufURS. Consistently using rfURS is more cost-efficient than the constant use of sufURS after 155 to 274 cases. We describe the first mathematical formula that allows a calculation and feasibility assessment of using both reusable and disposable fURS. To identify whether a hybrid system may be a feasible cost-efficient alternative to a rfURS-only program, any center can calculate the NIU-rfURS by entering center-specific data in the formula.
为了确定在我们中心哪种软性输尿管镜检查方案最具成本效益，我们进行了成本效益分析，并制定了一个评估混合模型成本效益可行性的公式。我们回顾性地计算了每例可重复使用软性输尿管镜（rfURS）的总成本，并与两种市售一次性软性输尿管镜（sufURS）进行了比较。我们从数据中得出了一个数学公式，以确定在仅为高破损风险病例使用 sufURS 的混合系统中，rfURS 的必要使用量增加（NIU-rfURS）以实现成本效益。在 57 个月内，我们使用 4 台数字式 rfURS（Flex-XC；STORZ）进行了 983 例手术，需要进行 45 次修复，总修复费用为 256809 欧元。包括每台 24000 欧元的资本投资和每 60 欧元的消毒循环费用，在 983 例手术后，每例的平均成本为 419 欧元。如果一直使用 sufURS，则成本将增加 55%至 127%（分别为 Uscope PU3022 和 Lithovue，制造商建议零售价分别为 650 欧元和 950 欧元）。按每例分析，成本最初极高，但在大约 400 例后降至 480 欧元左右的平台期。在进行 155 或 274 例手术之后，分别使用 rfURS 的方案比一直使用 Lithovue 或 Uscope PU3022 更具成本效益。根据我们的数据和公式，如果我们假设在 15%的病例中使用 Uscope PU3022 或 Lithovue，则 NIU-rfURS 分别为 28%或 74%（分别为 6 或 16 例）。随着 sufURS 使用量的增加，NIU-rfURS 呈指数增长。在 155 至 274 例手术后，持续使用 rfURS 比持续使用 sufURS 更具成本效益。我们描述了第一个数学公式，该公式允许计算和评估使用可重复使用和一次性 fURS 的可行性。为了确定混合系统是否可以作为仅使用 rfURS 方案的可行成本效益替代方案，任何中心都可以通过在公式中输入中心特定数据来计算 NIU-rfURS。
