Micro-cost analysis of single-use vs. reusable cystoscopy in a single-payer healthcare system.

ABSTRACT

INTRODUCTION: Single-use flexible diagnostic cystoscopy has recently been developed with comparable functionality to reusable cystoscopes. Prior studies have demonstrated considerable upfront costs of reusable cystoscopy. The objective of this study was to compare costs of reusable cystoscopy to single-use cystoscopy in a single-payer, socialized healthcare system. METHODS: A retrospective micro-cost analysis of reusable cystoscopy in a combined inpatient and outpatient setting at a single institution was performed. The cost analysis was divided into capital, maintenance, reprocessing, and labor. Annual costs were averaged over two fiscal years. Costs were amortized over five- and 10-year bases as appropriate. The results were compared to theoretical costs of single-use cystoscopes. RESULTS: There were 3415 annual average cystoscopy cases with 171 cases per reusable cystoscope. The capital, maintenance, reprocessing, and labor costs of reusable cystoscopy were $96 000, $99 867, $247 855, and $65 317, respectively. The total annual costs per case for reusable and single-use cystoscopy were $149.06 and $245.57, respectively. The costs of reusable cystoscopy decreased with the number of procedures per year and intersected the costs of single-use cystoscopes at 1265 procedures per year. All costs were calculated in Canadian dollars ($CAD). CONCLUSIONS: The cost-effectiveness of reusable cystoscopes is dependent on cystoscopy volume due to considerable upfront costs. Single-use cystoscopes are more cost-effective if the total number of cases performed is less than 1265 per year. Additional investigation into the cost-effectiveness of single-use cystoscopes as supplements in the outpatient setting or primary endoscopes in inpatient/emergency settings should be performed.