To Throw, or Not to Throw: Threshold Cost Analysis of the Single-Use Flexible Cystoscopy Model in a High-Volume...

Flexible cystoscopy is a common procedure in urology, traditionally performed using reusable flexible cystoscopes. However, concerns over sterilization costs, cross-contamination, and logistics have led to interest in single-use disposable cystoscopes. This study compares the cost-effectiveness of reusable versus disposable cystoscopes at a high-volume academic center. A retrospective threshold cost analysis was performed at a tertiary hospital in Singapore in 2022. Costs that were considered included device purchase, reprocessing and maintenance costs. Common procedural-related costs such as medical manpower costs and costs of consumables were not included in this analysis. In a high-volume center with an annual caseload of 3574 cystoscopies, we identified a cost-equivalent price at SGD 135, above which reusable cystoscopes became more cost-effective. This suggests reusable cystoscopes are economically advantageous in high-volume settings due to the inverse relationship between per-unit cost and annual caseload. However, disposable cystoscopes may still have value in lower-volume centers where the cost-equivalent price is higher. In conclusion, reusable cystoscopes offer cost-efficiency in high-throughput settings, whereas single-use scopes provide logistical and infection-control advantages in selected scenarios. Ongoing evaluation of cost and clinical outcomes is needed to optimize cystoscopy practices.