Analysis of the Costs and Carbon Footprint Associated With Reusable Flexible Cystoscopes: Implications for the Utilization of Single-Use Digital Flexible Cystoscopes

OBJECTIVES: Cystoscopy is one of the most common diagnostic endoscopic examinations in the field of urology. While the first cystoscope can be traced to the early 1800’s, the flexible cystoscope for visualizing the urinary bladder via the urethra did not emerge until 1973. Recently, single-use flexible cystoscopes have been introduced which avoid the numerous reprocessing steps required for reusable cystoscopes. Organizations contemplating the utilization of single-use devices must consider their costs against the costs associated with reusable devices as well as the environmental impact of both. An analysis was performed to advise organizations on the various costs and carbon footprint associated with reusable flexible cystoscopes.

METHODS: A comprehensive literature review of the various costs and environmental impact associated with reusable flexible cystoscopes was undertaken. When available, comparisons with single-use cystoscopes were employed. The costs analyzed included the amortized cost of the reusable flexible cystoscope, reprocessing costs, repair costs, incremental operating room time, and the incremental cost associated with postoperative infections.

RESULTS: The median per-case cost for utilizing a reusable flexible cystoscope was found to be $600/€561: amortized cost of the cystoscope - $64/€59 (2 studies), reprocessing cost - $74/€69 (4 studies), per-case repair cost - $44/€41 (2 studies), cost of incremental OR time - $295/€276 (3 studies), per-case cost of incremental postoperative infections - $123/€115 (1 study). The median carbon dioxide equivalent produced per case for a reusable cystoscope was found to be 3.66kg (2 studies) and 2.24kg for a single-use cystoscope.

CONCLUSIONS: Organizations should consider this analysis and adjust parameters based on their costs, history, experience with reusable flexible cystoscopes, and extensibility of the environmental factors cited. Those customized, facility-specific findings may advise on the selection of single-use digital flexible cystoscopes as economical alternatives with a lower carbon footprint compared to reusable devices.