Comprehensive Costs Associated with Fiberoptic and Digital Flexible Ureteroscopes at a High Volume Teaching Hospital

Introduction Modern flexible ureteroscope ownership costs are considerable. Most prior estimates focus exclusively on repair costs, likely underestimating overall costs, including those of acquisition and reprocessing. Furthermore, to our knowledge no prior cost analyses focus on the latest generation digital flexible ureteroscope, which may differ due to unique purchase and repair prices. We sought to gain greater insight into the comprehensive costs associated with modern flexible ureteroscope use, particularly the difference between digital and fiberoptic models. Methods Data on use and repair of fiberoptic Storz Flex-X² and digital Flex-X^c flexible ureteroscopes from 2011 to 2015 were reviewed. List prices and repair costs were obtained from Storz. Per case reprocessing costs were estimated, accounting for disposables, reagents and labor. Maintenance costs were estimated by combining cost of repairs and reprocessing. Analyses were performed at list pricing and standard discount rates. Global flexible ureteroscope costs were calculated to account for the cost of acquisition, repair and maintenance of a new scope during its first 100 uses. Results Global costs associated with digital flexible ureteroscope ownership were 1.3 to 1.4 times greater than fiberoptic on a per case basis ($1,008/$1,086 vs $715/$835). The majority of expenses went toward scope repairs (73% vs 71%), with instrument purchase (23% vs 24%) and reprocessing (4% vs 5%) being less costly. Repair rates were not significantly different between fiberoptic and digital devices (12.5 vs 11.5, p=0.757). Conclusions Expenditures associated with ownership of modern flexible ureteroscopes are considerable and driven primarily by the high cost of repairs. Digital instruments are more costly despite comparable rates of flexible ureteroscope damage.