Presentation Authors: Benjamin PRADERE*, Dubnitskiy-Robin Sophie, benjamin Faivre D'Arcier, Sophie Watt, Tanguy Le Fol, Eric Rusch, Fanny Monmousseau, Sylvie Brunet-Houdard, Tours, France
Introduction: The recent development of single-use ureteroscopes raises the question of their place in healthcare facilities. The objective was to assess the budget impact, for a public hospital, of their diffusion over a 5-year horizon, in the treatment of urolithiasis.
Methods: Budget impact was estimated by taking into account therapeutic strategy switch (between ureteroscopy and extracorporeal shockwave lithotripsy) due to changes in recommendations of urolithiasis treatment and to an induced demand, linked to the single-use device acquisition. Input parameters values were determined from national or local hospital expenditure databases. We considered costs and revenues of hospital stays, a list price of single-use ureteroscope (LithoVueTM) and a production cost of reusable ureteroscope measured by micro-costing. A minimum threshold value for the use of the reusable ureteroscope was determined (hybrid strategy).
Results: The budget impact over 5 years, for a public hospital was respectively estimated for fiberoptic and numeric reusable ureteroscopes at â‚¬ 709,218 and â‚¬ 567,900, under the assumption of a 100% single-use ureteroscopes diffusion rate. This represented respectively an annual mean overcost of â‚¬639 and â‚¬512 by patient. The concomitant implementation of several levers would decrease significantly this impact: negotiation of retail price of single-use ureteroscopes, expansion of outpatient stays and reduction of production costs. A hybrid strategy would be cost-effective if at least 25% of patients were treated by a numeric reusable ureteroscope (10% in case of fiberoptic reusable device). We showed that this threshold values depends on the purchase price and the number of patients treated.
Conclusions: The budget impact of 100% single-use switch is not negligible for a public hospital, in the context of health expenditures rationalization. Some leeways have been identified to reduce this impact. Moreover, below some volume of interventions performed with a multiple-use device, the hybrid strategy is sub-optimal and it is preferable to use single-use ureteroscopes only.