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

Abstract

Objective: 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.

Materials and methods: 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.

Results: 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.

Conclusion: 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.