Cost Analysis and Service Delivery on Using Isiris α™ To Remove Ureteric Stents

Main Article Content

Yih Chyn Phan
Jonathan Cobley
Wasim Mahmalji

Keywords

Cost Analysis, Service Delivery, Isiris α™, Ureteric Stents

Abstract

Introduction


Isiris α™ (Coloplast®) is an innovative single-use disposable flexible cystoscope with an integrated ureteric stent grasper designed specifically to remove ureteric stents. It allows clinicians to remove ureteric stents easily on the wards or in clinics without the need of arranging a routine and dedicated flexible cystoscopy appointment for patients. We evaluated Isiris α’s practical use and cost analysis against traditional reusable endoscopes.


Method


We compared the cost of removing ureteric stents using Isiris α™ in 10 patients prospectively versus traditional flexible cystoscopes in 10 patients retrospectively. The costs of the equipment, medications, reprocess machines, and utility costs were consulted from the relevant departments and companies. As for labour cost, we have sourced British Medical Association (BMA) and Royal College of Nursing (RCN) websites.


Results


From our study, it costs £260.65 and £123.41 on average to remove a ureteric stent using Isiris α™ and traditional flexible cystoscope respectively (p<0.001). Stent removal in the endoscopy department was delayed in 60% of patients, on average 6.4 days, compared to 0% of patients using Isiris α™ (p = 0.048).


Conclusion


Although Isiris α™ is shown to be a more expensive option to remove ureteric stents based on our analysis, it still provides clinicians flexibility and ease in removing ureteric stents in the outpatient clinic, reducing the pressure and demand for dedicated flexible cystoscopy slots in the endoscopy department.

Abstract 574 | pdf Downloads 493

References

1. Zakri R, Khan S. Ureteric Stents. In: Muneer A, Pearce I, Ralph D. Prosthetic Surgery in Urology. Switzerland: Springer International Publishing; 2016.
2. Lowry P. Ureteroscopy: Stents and Other Adjuncts. In: Nakada S, Pearle M. Surgical Management of Urolithiasis: Percutaneous, Shockwave and Ureteroscopy. New York: Springer Science + Business Media; 2013:125–36.
3. Manatakis DK, Georgopoulos N. Reducing the cost of laparoscopy: reusable versus disposable laparoscopic instruments. Minim Invasive Surg 2014;2014:408171.
4. Shussman N, Kedar A, Elazary R, et al. Reusable single-port access device shortens operative time and reduces operative costs. Surg Endosc 2014;28(6):1902–907.
5. Siu J, Hill AG, MacCormick AD. Systematic review of reusable versus disposable laparoscopic instruments: costs and safety. ANZ J Surg 2017;87(1–2):28–33.
6. Aïssou M, Coroir M, Debes C, et al. Analyse de coût comparant les fibroscopes à usage unique (Ambu® aScope™) et les fibroscopes réutilisables pour l’intubation difficile. Ann Fr Anesth Reanim 2013;32(5):291–95.
7. Tvede MF, Kristensen MS, Nyhus-Andreasen M. A cost analysis of reusable and disposable flexible optical scopes for intubation. Acta Anaesthesiol Scand 2012;56(5):577–84.
8. Nanta P, Senarat W, Tribuddharat C, et al. Cost-effectiveness and safety of reusable tracheal suction tubes. J Med Assoc Thai 2005;88 Suppl 10:S86–88.
9. Soulias M, Martin L, Garnier N, et al. Masques laryngés à usage unique vs réutilisable: une étude de minimisation de coûts. Ann Fr Anesth Reanim 2006;25(8):811–14.
10. Bourguignon C, Destrumelle AS, Koch S, et al. Disposable versus reusable biopsy forceps in GI endoscopy: a cost-minimization analysis. Gastrointest Endosc 2003;58(2):226–29.
11. Hogan RB, Santa-Cruz R, Weeks ES Jr, et al. Cost-minimization analysis of jumbo reusable forceps versus disposable forceps in a high-volume ambulatory endoscopy center. Gastrointest Endosc 2009;69(2):284–88.
12. Sherman JD, Raibley LA 4th, Eckelman MJ. Life cycle assessment and costing methods for device procurement: comparing reusable and single-use disposable Laryngoscopes Anesth Analg 2018; Jan 9. doi: 10.1213/ANE.0000000000002683. [Epub ahead of print]
13. Canales BK, Gleason JM, Hicks N, et al. An independent analysis of flexible cystoscope repairs and cost. J Urol 2007;178(5):2098–102.
14. McGill JJ, Schaeffer AJ, Gonzalez CM. Durability of flexible cystoscopes in the outpatient setting. Urology 2013;81(5):932–37.
15. Spaulding EH. Chemical disinfection of medical and surgical materials. In: Lawrence C, Block SS, editors. Disinfection, sterilization, and preservation. Philadelphia: Lea & Febiger; 1968.
16. Rutala WA, Weber DJ. Disinfection and sterilization: an overview. Am J Infect Control 2013;41(5):S2–5.
17. Rutala WA, Weber DJ. Reprocessing semicritical items: Current issues and new technologies. Am J Infect Control 2016;44(5):e53–62.
18. Saliou P, Le Bars H, Fournier G, Baron R. Évaluation microbiologique de la désinfection des cystoscopes souples au CHRU de Brest de janvier 2007 à décembre 2014. Prog Urol 2016;26(2):103–107.
19. Saviuc P, Picot-Guéraud R, Shum Cheong Sing J, et al. Evaluation of the Quality of Reprocessing of Gastrointestinal Endoscopes. Infect Control Hosp Epidemiol 2015;36(9):1017–23.
20. Muscarella LF. Risk of transmission of carbapenem-resistant Enterobacteriaceae and related ‘superbugs’ during gastrointestinal endoscopy. World J Gastrointest Endosc 2014;6:457–74.
21. Epstein L, Hunter JC, Arwady MA, et al. New Delhi metallo-beta-lactamase-producing carbapenem-resistant Escherichia coli associated with exposure to duodenoscopes. JAMA 2014;312:1447–55.
22. Agerton T, Valway S, Gore B, et al. Transmission of a highly drug-resistant strain (strain W1) of Mycobacterium tuberculosis: community outbreak and nosocomial transmission via a contaminated bronchoscope. JAMA 1997;278:1073–77.
23. Michele TM, Cronin WA, Graham NM, et al. Transmission of Mycobacterium tuberculosis by a fiberoptic bronchoscope: identification by DNA fingerprinting. JAMA 1997;278:1093–95.
24. Srinivasan A, Wolfenden LL, Song X, et al. An outbreak of Pseudomonas aeruginosa infections associated with flexible bronchoscopes. N Engl J Med 2003;348(3):221–27.
25. Kenters N, Huijskens EG, Meier C, et al. Infectious diseases linked to cross-contamination of flexible endoscopes. Endosc Int Open 2015;3(4):E259–65.
26. Koo V, O'Neill P, Elves A. Multidrug-resistant NDM-1 Klebsiella outbreak and infection control in endoscopic urology. BJU Int 2012;110:E922–26.
27. Jimeno A, Alcalde MM, Ortiz M, et al. Outbreak of urinary tract infections by Salmonella spp. after cystoscopic manipulation. Actas Urol Esp 2016;40(10):646–49.
28. Chang CL, Su LH, Lu CM, et al. Outbreak of ertapenem-resistant Enterobacter cloacae urinary tract infections due to a contaminated ureteroscope. J Hosp Infect 2013;85:118–24.
29. Wendelboe AM, Baumbach J, Blossom DB, et al. Outbreak of cystoscopy related infections with Pseudomonas aeruginosa: New Mexico, 2007. J Urol 2008;180(2):588–92.
30. Malavaud S, Boiteux JP, Coloby P, et al. Flexible cystoscopes: disinfection and microbiological surveillance practices among French urologists. Prog Urol 2012;22(12):731–35.
31. Clemens JQ, Dowling R, Foley F, et al; American Urological Association; Society of Urologic Nurses and Associates. Joint AUA/SUNA white paper on reprocessing of flexible cystoscopes. J Urol 2010;184(6):2241–45.
32. Moses FM, Lee J. Surveillance cultures to monitor quality of gastrointestinal endoscope reprocessing. Am J Gastroenterol 2003;98(1):77–81.
33. Chiu KW, Fong TV, Wu KL, et al. Surveillance culture of endoscope to monitor the quality of high-level disinfection of gastrointestinal reprocessing. Hepatogastroenterology 2010;57(99-100):531–34.
34. Tunuguntla A, Sullivan MJ. Monitoring quality of flexible endoscope disinfection by microbiologic surveillance cultures. Tenn Med 2004;97(10):453–56.
35. Upreti VV, Barbour AM. Antibiotics Development and the Emergence of Resistance: Clinical Pharmacology to the Rescue. J Clin Pharmacol 2018; Jan 12. doi: 10.1002/jcph.1057. [Epub ahead of print]
36. Ghafur A. Call for global action to halt the superbug. Med J Aust 2013;198(5):251.
37. West K. Infection control update: the emerging threat of CRE. A potential new superbug resists antibiotics. EMS World 2013;42(11)39:41–44.
38. Lee BY, Bartsch SM, Wong KF, et al. The potential trajectory of carbapenem-resistant enterobacteriaceae, an emerging threat to health-care facilities, and the impact of the Centers for Disease Control and Prevention Toolkit. Am J Epidemiol 2016;183(5):471–79.
39. McDonnell G, Burke P. Disinfection: is it time to reconsider Spaulding? J Hosp Infect 2011;78(3):163–70.
40. Lewis T, Patel V, Ismail A, et al. Sterilisation, disinfection and cleaning of theatre equipment: do we need to extend the Spaulding classification? J Hosp Infect 2009;72(4):361–63.
41. Humphries R, McDonnell G. Superbugs on duodenoscopes: the challenge of cleaning and disinfection of reusable devices. J Clin Microbiol 2015;53(10): 3118–25.
42. Rutala WA, Weber DJ. Gastrointestinal endoscopes: a need to shift from disinfection to sterilization? JAMA 2014;312(14):1405–6.
43. Emiliani E, Traxer O. Single use and disposable flexible ureteroscopes. Curr Opin Urol 2017;27(2):176–81.
44. Tom WR, Wollin DA, Jiang R, Radvak D, Simmons WN, Preminger GM, Lipkin ME. Next-generation single-use ureteroscopes: an in vitro comparison. J Endourol 2017;31(12):1301–6.
45. Kurniawan N, Keuchel M. Flexible gastro-intestinal endoscopy — clinical challenges and technical achievements. Comput Struct Biotechnol J 2017;15:168–79.
46. Patel N, Darzi A, Teare J. The endoscopy evolution: ‘the superscope era’. Frontline Gastroenterol 2015;6(2):101–7.
47. Rösch T, Adler A, Pohl H, et al. A motor-driven single-use colonoscope controlled with a hand-held device: a feasibility study in volunteers. Gastrointest Endosc 2008;67(7):1139–46.
48. Irvine W, Bradley S, Minford E. Novel use of Ambu® aScope™ 2 for choledochoscopy. Int Journal of Surg 2014;12:S21.
49. Aawsaj Y, Light D, Brown J, et al. Use of the Ambu® aScope 2™ in laparoscopic common bile duct exploration. Surg Endosc 2016;30(11):5153–55.
50. Talso M, Emiliani E, Baghdadi M, et al. The new grasper-integrated single use flexible cystoscope for double J stent removal: evaluation of image quality, flow and flexibility. World J Urol 2017;35(8):1277–83.
51. Doizi S, Kamphuis G, Giusti G, et al. First clinical evaluation of a new single-use flexible cystoscope dedicated to double-J stent removal (Isiris™): a European prospective multicenter study. World J Urol. 2017;35(8):1269–75.
52. Smith PM, Harbias A, Robinson R, et al. Isiris: A Novel Method of Removing Foreign Bodies from the Lower Urinary Tract to Avoid Unnecessary Hospitalization and Anesthesia. J Endourology Case Rep 2016;2(1):144–47.
53. Gupta D, Wang H. Cost-effectiveness analysis of flexible optical scopes for tracheal intubation: a descriptive comparative study of reusable and single-use scopes. J Clin Anesth 2011;23:632–35.
54. Aïssou M, Coroir M, Debes C, et al. Cost analysis comparing single-use (Ambu® aScope™) and conventional reusable fiberoptic flexible scopes for difficult tracheal intubation. Ann Fr Anesth Reanim 2013;32(5):291–95.
55. Perbet S, Blanquet M, Mourgues C, et al. Cost analysis of single-use (Ambu® aScope™) and reusable bronchoscopes in the ICU. Ann Intensive Care 2017;7(1):3.
56. Marshall DC, Dagaonkar RS, Yeow C, et al. Experience with the use of single-use disposable bronchoscope in the icu in a tertiary referral center of Singapore. J Bronchology Interv Pulmonol 2017;24(2):136–43.
57. Tvede MF, Kristensen MS, Nyhus-Andreasen M. A cost analysis of reusable and disposable flexible optical scopes for intubation. Acta Anaesthesiol Scand 2012;56(5):577–84.
58. Edenharter GM, Gartner D, Pförringer D. Decision support for the capacity management of bronchoscopy devices: optimizing the cost-efficient mix of reusable and single-use devices through mathematical modeling. Anesth Analg 2017;124(6):1963–67.
59. Ozimek T, Schneider MH, Hupe MC, et al. Retrospective cost analysis of a single-center reusable flexible ureterorenoscopy program: a comparative cost simulation of disposable fURS as an alternative. J Endourol 2017;31(12):1226–30.
60. Taguchi K, Usawachintachit M, Tzou DT, et al. Micro-costing analysis demonstrates comparable costs for LithoVue™ compared to reusable flexible fiberoptic ureteroscopes. J Endourol 2017;Dec 14. doi: 10.1089/end.2017.0523. [Epub ahead of print]