The Cost-Effectiveness of Treatment Modalities for Ureteral Stones

Siu, Justin Ji-Yuen; Chen, Huey‐Yi; Liao, Po-Chi; Chiang, Jen‐Huai; Chang, Chao‐Hsiang; Chen, Yung‐Hsiang; Chen, Wen‐Chi

doi:10.1177/0046958016669015

Cited by 3 publications

(2 citation statements)

References 22 publications

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“…This is mainly influenced by the generation of the disposable scope and by the business contract with the manufacturer. Recent purchase prices reported for the existing scopes are US$ 1300 to US$ 3180 for LithoVue TM (22, 42, 52, 53), US$ 700 for Polyscope TM (34), and US$ 800 for SemiFlex TM (14). As the manufacturing process of single-use scopes become more effective, less instruments are discarded and final retail cost may fall.…”

Section: Resultsmentioning

confidence: 99%

A comprehensive literature-based equation to compare cost-effectiveness of a flexible ureteroscopy program with single-use versus reusable devices

et al. 2019

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Purpose: to critically review all literature concerning the cost-effectiveness of fl exible ureteroscopy comparing single-use with reusable scopes. Materials and Methods: A systematic online literature review was performed in PubMed, Embase and Google Scholar databases. All factors potentially affecting surgical costs or clinical outcomes were considered. Prospective assessments, case control and case series studies were included. Results: 741 studies were found. Of those, 18 were duplicated and 77 were not related to urology procedures. Of the remaining 646 studies, 59 were considered of relevance and selected for further analysis. Stone free and complication rates were similar between single-use and reusable scopes. Operative time was in average 20% shorter with digital scopes, single-use or not. Reusable digital scopes seem to last longer than optic ones, though scope longevity is very variable worldwide. New scopes usually last four times more than refurbished ones and single-use ureterorenoscopes have good resilience throughout long cases. Longer scope longevity is achieved with Cidex and if a dedicated nurse takes care of the sterilization process. The main surgical factors that negatively impact device longevity are lower pole pathologies, large stone burden and non-use of a ureteral access sheath. We have built a comprehensive fi nancial costeffective decision model to fl exible ureteroscope acquisition. Conclusions: The cost-effectiveness of a fl exible ureteroscopy program is dependent of several aspects. We have developed a equation to allow a literature-based and adaptable decision model to every interested stakeholder. Disposable devices are already a reality and will progressively become the standard as manufacturing price falls.

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Section: Resultsmentioning

confidence: 99%

A comprehensive literature-based equation to compare cost-effectiveness of a flexible ureteroscopy program with single-use versus reusable devices

et al. 2019

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“…Of the remaining 646 studies, 59 published between 2000 and 2018 were considered of relevance to the pre-defined queries and were selected for further analysis. The studies consisted of four randomized controlled trial 9,11,38,56 , three multicenter trials 17,30,33 , 40 case series 5,8,10,12,13,15,16,[25][26][27][28][29]31,32,[34][35][36][37]39,41,42,[44][45][46][47][48][49][50][51][52]54,55,[57][58][59][60][61][62][63]66 , one cadaveric feasibility study 18 , one animal feasibility study 19 , and ten bench top studies…”

Section: Resultsmentioning

confidence: 99%

Single-use versus reusable flexible ureteroscopes: a comprehensive cost-analysis decision model

Marchini

Torricelli

Batagello

et al. 2018

Rev. Med. (São Paulo)

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Purpose: The significant improvements in flexible ureterorenoscopes have made flexible ureteroscopy the main treatment modality to target upper urinary pathologies. The purpose of this study was to critically evaluate all literature concerning the cost-effectiveness of flexible ureteroscopy comparing single-use with reusable scopes. Methods: A systematic online literature review was performed in PubMed, Embase and Google Scholar databases. Two separate urologists (GSM and FCT) performed the online search and reviewed all papers considered suitable and relevant for this analysis. Because of the paucity of high quality publications, not only prospective assessments but also case control and case series studies were included in the final analysis. All factors potentially affecting surgical costs or clinical outcomes were considered in the analysis. Results: 741 studies with the previously elected terms were found. Of those, 18 were duplicated and 77 were not related to urology procedures and were excluded. Of the remaining 646 studies, 59 published between 2000 and 2018 were considered of relevance to the pre-defined queries and were selected for further analysis. Stone free and complication rates were similar between single-use and reusable scopes. In special, urinary tract infection rate following flexible ureteroscopy is not inferior if a single-use device is used instead of a reusable scope. Operative time was in average 20% shorter if a digital scope was used, single-use or not. There is a suggestion that the learning curve is shorter with single-use devices but this is not consistent in the literature. Surgeon expertise impacts the longevity of the flexible scope. Reusable digital scopes seem to last longer than optic ones, though scope longevity is very variable worldwide. New scopes usually last three to four times more than refurbished ones and single-use ureterorenoscopes have good resilience throughout long cases. Both sterilization method and cleaning process impact scope longevity, the best results being achieved with Cidex and a dedicated nurse to take care of the sterilization process. The main factors that negatively impact device longevity regarding patient and disease are lower pole pathologies, large stone burden and non-use of a ureteral access sheath. Conclusions: The cost-effectiveness of a flexible ureteroscopy program is dependent of several aspects that must be considered when deciding whether to choose between a single-use and a reusable ureterorenoscope. Disposable devices are already a reality and will progressively become the standard as manufacturing price falls significantly.

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