Green endoscopy: Economic and ecological evaluation of single-use versus reusable ureterorenoscopes

The number of ureterorenoscopies in Germany is rising. Hospitals must operate economically while ensuring quality. Environmental assessment of medical procedures is gaining focus. This study aims to perform a comparative analysis of the economic and ecological aspects of single-use versus reusable ureterorenoscopes using real-world routine data, acknowledging their trade-offs between hygienic advantages, costs and environmental impacts.

A total of 210 ureterorenoscopy cases (2022/2023) at the University Hospital of Würzburg were evaluated. A simulation assessed the impact of the OPS code 5-98b.0 on DRG (diagnosis-related groups) classification and reimbursement. Economic analysis included acquisition, repair and sterilization costs, while ecological assessment considered manufacturing, waste, reprocessing, transport and repair.

In 44.3% of cases, use of OPS code 5-98b.0 resulted in an upgraded DRG (L20B instead of L20C), yielding approximately €62 000 in additional revenue over 2 years. This was outweighed by roughly €147 000 in extra costs for single-use devices, assuming repair costs for reusable devices remained around €300 per case. Environmentally, single-use devices generated 42 kg more CO₂ per 100 procedures.

Single-use ureterorenoscopes are economically justifiable only when reusable devices incur frequent repair costs. Reusable scopes perform better ecologically due to lower CO₂ emissions. Instrument choice should be guided by each clinic's specific economic and environmental context.