Cost associated with Reusable fURS

• Acquisition cost of one reusable fURS
  Acquisition cost of one reusable fURS

  Parameter Explanation

  Acquisition cost of one reusable fURS is the cost of owning one digital or fiber-optic reusable flexible ureteroscope. If a combination of digital and fiber-optic reusable flexible ureteroscopes are used, then please use an average of the total cost.

  Please enter your value here.
• Number of reusable fURS owned/maintained
  Number of reusable fURS owned/maintained

  Parameter Explanation

  Number of reusable fURS owned/maintained is the total number number of digital and fiber-optic reusable flexible ureteroscopes owned or maintained in your institution.

  Please enter your value here.
• Number of flexible ureteroscopy cases performed per year
  Number of flexible ureteroscopy cases performed per year

  Parameter Explanation

  Number of flexible ureteroscopy cases performed per year is the typical number of times that a reusable fURS will be used per year at the subject institution. All usage of a reusable fURS should be considered, including diagnostic procedures and cancer procedures - not simply the use of those devices to treat renal stones.

  Please enter your value here.
• Typical lifetime uses of a reusable fURS (years)
  Typical lifetime uses of a reusable fURS (years)

  Parameter Explanation

  Typical lifetime uses of a reusable fURS is the typical lifetime in years that a single digital or fiber-optic reusable flexible ureteroscope will either last or before it is replaced due to obsolescence of the technology.

  Values of 3, 4 and 9 years have been reported in the literature.

  Please enter your value here.

  References:

  • Taguchi K, Usawachintachit M, Tzou DT, et al. Micro-Costing Analysis Demonstrates Comparable Costs for LithoVue Compared to Reusable Flexible Fiberoptic Ureteroscopes. J Endourol. 2018;32(4):267-273.

  • Al-Balushi K, Martin N, Loubon H, et al. Comparative medico-economic study of reusable vs. single-use flexible ureteroscopes. International urology and nephrology. 2019 Jul 17:1-7.

  • Mager R, Kurosch M, Höfner T, et al. Clinical outcomes and costs of reusable and single-use flexible ureterorenoscopes: a prospective cohort study. Urolithiasis. 2018 Nov 1;46(6):587-93.

  4 (Median - Default) 9 (Mager 2018) 4 (Al Balushi 2019) 3 (Taguchi 2018)
• Amortized per-case acquisition cost of a reusable fURS
  TBD

Repair:

• Percent of all reusable fURS failures that occur mid-case
  Percent of all reusable fURS failures that occur mid-case

  Parameter Explanation

  Percent of all reusable fURS failures that occur mid-case is the percentage of the time when the failure or breakage of the digital or fiber-optic reusable flexible ureteroscope occurs mid-case as opposed to breakage that occurs during reproccessing. The value is used to compute the percentage of failures that require the broken scope to be reprocessed before they can be returned to the manufacturer or third-party for repair.

  A value of 28% - only 28% of failures occur mid-case - has been reported in the literature.

  Please enter your value here.

  Reference:

  • Sooriakumaran P, Kaba R, Andrews HO, Buchholz NP. Evaluation of the mechanisms of damage to flexible ureteroscopes and suggestions for ureteroscope preservation. Asian J Androl. 2005;7(4):433-8.
• Average cost of repairing a reusable fURS
  Average cost of repairing a reusable fURS

  Parameter Explanation

  Average cost of repairing a reusable fURS is the per case average cost of repairing a broken or damaged digital or fiber-optic reusable flexible ureteroscope.

  If the average cost of repairing a reusable fURS is known, please enter your value here. Otherwise the model will prepopulate the cell with the default value.

  Default (Source and Assumption)

  The default average cost of repairing a reusable fURS is $5,580 (median of 12 costs of repairing a reusable fURS reported in six studies).

  References:

  • Hennessey DB, Fojecki GL, Papa NP, Lawrentschuk N, Bolton D. Single-use disposable digital flexible ureteroscopes: an ex vivo assessment and cost analysis. BJU Int. 2018;121:55-61. ($8,104)

  • Kramolowsky E, Mcdowell Z, Moore B, et al. Cost Analysis of Flexible Ureteroscope Repairs: Evaluation of 655 Procedures in a Community-Based Practice. J Endourol. 2016;30(3):254-6.($7,521)

  • Shah K, Monga M, Knudsen B. Prospective Randomized Trial Comparing 2 Flexible Digital Ureteroscopes: ACMI/Olympus Invisio DUR-D and Olympus URF-V. Urology. 2015;85(6):1267-71. ($6,600)

  • Landman J, Lee DI, Lee C, Monga M. Evaluation of overall costs of currently available small flexible ureteroscopes. Urology. 2003;62(2):218-22. ($5,900, $5,900, $5,410, $3,900, $3,495)

  • Tosoian JJ, Ludwig W, Sopko N, Mullins JK, Matlaga BR. The effect of repair costs on the profitability of a ureteroscopy program. J Endourol. 2015;29(4):406-9. ($5,750)

  • Mager R, Kurosch M, Höfner T, et al. Clinical outcomes and costs of reusable and single-use flexible ureterorenoscopes: a prospective cohort study. Urolithiasis. 2018 Nov 1;46(6):587-93. ($2,480, $4,535)

  • Carey RI, Martin CJ, Knego JR. Prospective evaluation of refurbished flexible ureteroscope durability seen in a large public tertiary care center with multiple surgeons. Urology. 2014;84(1):42-5. ($4,182)

  $5,580 (Median - Default) $8,104 (Hennessey 2018) $7,521 (Kramolowsky 2016) $6,600 (Shah 2015) $5,900 (Landman 2003, Mfc1) $5,900 (Landman 2003, Mfc2) $5,750 (Tosoian 2015) $5,410 (Landman 2003) $4,535 (Mager 2018) $4,182 (Carey 2014) $3,900 (Landman 2003) $3,495 (Landman 2003) $2,480 (Mager 2018)
• Average cost of removing a reusable fURS for repair
  Average cost of removing a reusable fURS for repair

  Parameter Explanation

  Average cost of removing a reusable fURS for repair is the per case average cost of removing a broken or damaged digital or fiber-optic reusable flexible ureteroscope so a repair can be conducted.

  If the average cost of removing reusable fURS for repair is known, please enter your value here. Otherwise the model will prepopulate the cell with the default value.

  Default (Source and Assumption)

  The default average cost of removing reusable fURS for repair is $139.39.

  Reference:

  • Isaacson D, Ahmad T, Metzler I, et al. Defining the Costs of Reusable Flexible Ureteroscope Reprocessing Using Time-Driven Activity-Based Costing. J Endourol. 2017;31(10):1026-1031
• Number of cases between repairs*
  Number of cases between repairs

  Parameter Explanation

  Number of cases between repairs is the total number of urolithiasis cases observed between a repair of a broken or damaged digital or fiber-optic reusable flexible ureteroscope is conducted.

  If the number of cases between repairs is known, please enter your value here. Otherwise the model will prepopulate the cell with the default value.

  Default (Source and Assumption)

  The default median number of cases between repairs is 11 (median value of 25 values reported in 13 studies).

  References:

  • Karaolides T, Bach C, Kachrilas S, et al. Improving the durability of digital flexible ureteroscopes. Urology. 2013;81(4):717-22. (21.6, 10.6)

  • Kramolowsky E, Mcdowell Z, Moore B, et al. Cost Analysis of Flexible Ureteroscope Repairs: Evaluation of 655 Procedures in a Community-Based Practice. J Endourol. 2016;30(3):254-6. (21.0)

  • DiBianco JM, Twum-Ampofo J, Rolef JB, et al. Contract Costs Associated with Maintaining Flexible Ureteroscopes: A Single Center Experience. Urology Practice. 2017;4(5):363-364. (19.9, 11.0)

  • Knudsen B, Miyaoka R, Shah K, et al. Durability of the next-generation flexible fiberoptic ureteroscopes: a randomized prospective multi-institutional clinical trial. Urology. 2010;75(3):534-8. (18.0, 17.6, 17.3, 5.3)

  • Martin CJ, McAdams SB, Abdul-Muhsin H, et al. The Economic Implications of a Reusable Flexible Digital Ureteroscope: A Cost-Benefit Analysis. J Urol. 2017;197(3 Pt 1):730-735. (12.5)

  • Ozimek T, Schneider MH, Hupe MC, et al. Retrospective cost analysis of a single-center reusable flexible ureterorenoscopy program: a comparative cost simulation of disposable fURS as an alternative. Journal of endourology. 2017 Dec 1;31(12):1226-30. (14.4)

  • Shah K, Monga M, Knudsen B. Prospective Randomized Trial Comparing 2 Flexible Digital Ureteroscopes: ACMI/Olympus Invisio DUR-D and Olympus URF-V. Urology. 2015;85(6):1267-71. (14, 11.25)

  • Carey RI, Gomez CS, Maurici G, Lynne CM, Leveillee RJ, Bird VG. Frequency of ureteroscope damage seen at a tertiary care center. J Urol. 2006;176(2):607-10. (11.1)

  • Hennessey DB, Fojecki GL, Papa NP, et al. Single‐use disposable digital flexible ureteroscopes: an ex vivo assessment and cost analysis. BJU international. 2018 May;121:55-61. (11.0)

  • Tosoian JJ, Ludwig W, Sopko N, Mullins JK, Matlaga BR. The effect of repair costs on the profitability of a ureteroscopy program. J Endourol. 2015;29(4):406-9. (9.5)

  • Taguchi K, Harper JD, Stoller ML, et al. Identifying factors associated with need for flexible ureteroscope repair: a Western Endourology STone (WEST) research consortium prospective cohort study. Urolithiasis. 2018 Nov 1;46(6):559-66. (7.3)

  • Carey RI, Martin CJ, Knego JR. Prospective evaluation of refurbished flexible ureteroscope durability seen in a large public tertiary care center with multiple surgeons. Urology. 2014;84(1):42-5. (6.9)

  • Monga M, Best S, Venkatesh R, et al. Durability of flexible ureteroscopes: a randomized, prospective study. J Urol. 2006;176(1):137-41. (14.4, 9.5, 8.5, 6.5, 4.5, 4.0, 3.25)

  11.0 (Median - Default) 21.6 (Karaolides 2013) 21.0 (Kramolowsky 2016) 19.9 (DiBianco 2017) 18.0 (Knudsen 2010) 17.6 (Knudsen 2010) 17.3 (Knudsen 2010) 14.4 (Ozimek 2017) 14.4 (Monga 2006) 14.0 (Shah 2015) 12.5 (Martin 2017) 11.25 (Shah 2015) 11.1 (Carey 2006) 11.0 (DiBianco 2017) 11.0 (Hennessey 2018) 10.6 (Karaolides 2013) 9.5 (Tosoian 2015) 9.5 (Monga 2006) 8.5 (Monga 2006) 7.3 (Taguchi 2018) 6.9 (Carey 2014) 6.5 (Monga 2006) 5.3 (Knudsen 2010) 4.5 (Monga 2006) 4.0 (Monga 2006) 3.25 (Monga 2006)
• Average per-case cost of reusable fURS repairs
  $535

Reprocessing:

• Average cost of reprocessing a reusable fURS
  Average cost of reprocessing a reusable fURS

  Parameter Explanation

  Average cost of reprocessing a reusable fURS is the per case average cost of reprocessing a repaired digital or fiber-optic reusable flexible ureteroscope before using it in the regular practice. The cost of reprocessing a scope includes consumable costs (one-time-use cleaning and disinfection materials) and labor cost (disinfection, cleaning and testing).

  If the average cost of reprocessing a reusable fURS is known, please enter your value here. Otherwise the model will prepopulate the cell with the default value.

  Default (Source and Assumption)

  The default average cost of reprocessing a reusable fURS is $107 (median of three costs of reprocessing a reusable fURS reported in three studies).

  References:

  • Mager R, Kurosch M, Höfner T, et al. Clinical outcomes and costs of reusable and single-use flexible ureterorenoscopes: a prospective cohort study. Urolithiasis. 2018 Nov 1;46(6):587-93. ($108)

  • Taguchi K, Usawachintachit M, Tzou DT, et al. Micro-Costing Analysis Demonstrates Comparable Costs for LithoVue Compared to Reusable Flexible Fiberoptic Ureteroscopes. J Endourol. 2018;32(4):267-273. ($107)

  • Isaacson D, Ahmad T, Metzler I, et al. Defining the Costs of Reusable Flexible Ureteroscope Reprocessing Using Time-Driven Activity-Based Costing. J Endourol. 2017;31(10):1026-1031. ($96)

  $107 (Median - Default) $108 (Mager 2018) $107 (Taguchi 2018) $96 (Isaacson 2017)
• Average per-case cost of reusable fURS reprocessing
  $107

• Estimated additional OR time with a reusable fURS (mins)
  Estimated additional OR time with a reusable fURS (mins)

  Parameter Explanation

  Estimated additional OR time with a reusable fURS (mins) is the estimated additional time needed in minutes to complete a procedure with a reusable fURS compared to a single-use fURS.

  If the estimated additional OR time with a reusable fURS (mins) is known, please enter your value here. Otherwise the model will prepopulate the cell with the default value.

  Default (Source and Assumption)

  The default estimated additional OR time with a reusable fURS (mins) is 17.2 minutes.

  References:

  • Göger YE, Özkent MS, Kılınç MT, et al. Efficiency of retrograde intrarenal surgery in lower pole stones: disposable flexible ureterorenoscope or reusable flexible ureterorenoscope? World J Urol. Published online March 18, 2021. (10.9)

  • Usawachintachit M, Isaacson DS, Taguchi K, et al. A Prospective Case-Control Study Comparing LithoVue, a Single-Use, Flexible Disposable Ureteroscope, with Flexible, Reusable Fiber-Optic Ureteroscopes. J Endourol. 2017;31(5):468-475. (14.5)

  • Taguchi K, Usawachintachit M, Tzou DT, et al. Micro-Costing Analysis Demonstrates Comparable Costs for LithoVue Compared to Reusable Flexible Fiberoptic Ureteroscopes. J Endourol. 2018;32(4):267-273. (19.8)

  • Salvadó JA, Cabello JM, Moreno S, Cabello R, Olivares R, Velasco A. Endoscopic treatment of lower pole stones: is a disposable ureteroscope preferable? Results of a prospective case-control study. Cent European J Urol. 2019;72(3):280-284. doi:10.5173/ceju.2019.1962 (20.9)

  17.2 (Median - Default) 10.9 (Göger 2021) 14.5 (Usawachintachit 2017) 19.8 (Taguchi 2018) 20.9 (Salvadó 2019)
• Average cost of OR time ($/minute)
  Average cost of OR time ($/minute)

  Parameter Explanation

  Average cost of OR time ($/minute) is the average cost of one minute in operating room.

  If the average cost of OR time ($/minute) is known, please enter your value here. Otherwise the model will prepopulate the cell with the default value.

  Default (Source and Assumption)

  The default average cost of OR time ($/minute) is $37.

  References:

  • Pietropaolo A, Hughes T, Tear L, Somani BK. Comparison of ureteric stent removal procedures using reusable and single-use flexible cystoscopes following ureteroscopy and lasertripsy: a micro cost analysis. Cent European J Urol. 2020;73(3):342-348. doi:10.5173/ceju.2020.0159 ($10)

  • Childers CP, Maggard-gibbons M. Understanding Costs of Care in the Operating Room. JAMA Surg. 2018;153(4):e176233. ($37)

  • Girotto JA, Koltz PF, Drugas G. Optimizing your operating room: or, why large, traditional hospitals don't work. Int J Surg. 2010;8(5):359-67. ($60)

  $37 (Median - Default) $10 (Pietropaolo 2020) $37 (Childers 2018) $60 (Girotto 2010)
• Average incremental per-case cost of reusable fURS
  $636