Micro-cost analysis of reusable compared to affordable single-use flexible ureteroscopes

Introduction: Flexible ureteroscopy is increasingly used for managing upper urinary tract pathologies, particularly kidney stones. With the emergence of affordable, single-use flexible ureteroscopes (fURS) as an alternative to reusable systems, the contemporary economic impact of each device is unclear. We performed a micro-cost evaluation comparing reusable fURS with two single-use models in a single-payer Canadian healthcare system. Methods: The costs of reusable fURS were divided into acquisition, repair, and reprocessing expenses. Per-procedure costs for reusable fURS were calculated by dividing the total annual costs by the average annual number of procedures, whereas single-use costs were based solely on device prices. The total number of repairs and specific reasons for repairs were also collected for the entire reusable fURS fleet from 2022-2024. Results: At our center, an average of 418 procedures were performed annually using reusable fURS, with total annual costs of $102 420.60, equating to $245.03 per procedure. Reusable fURS become more cost-effective at volumes exceeding 130 cases compared to EU-Scope™ US 31E-12 and 83 cases compared to the Standard LithoVue™. Additionally, 65 repair events were recorded from 2022-2024, mainly due to distal tip leakage (77%). One repair was required for roughly 20 procedures (20.22:1). Conclusions: Our analysis indicates that reusable systems are more cost-efficient in high-volume settings, while single-use devices, especially the EU-Scope™, may be advantageous in lower-volume centers. In tertiary centers, the use of single-use fURS represents an excellent opportunity to preserve the durability of reusable fURS, particularly during complex procedures with a high risk of ureteroscope damage.