Cost Analysis Just One Aspect of Deciding Between Disposable and Reusable Instruments

An increasing range of medical equipment is now disposable in nature. In some areas there is a tricky choice to be made between disposable and reusable options, with arguments for and against each. In this issue, Foo et al. have reported on threshold cost considerations that may help in the choice between disposable and reusable flexible cystoscopes 1. Notably, the outcome of their cost comparison methodology depends very much on specifics of local costs and caseload and hence may vary case by case. However, even in centres where reusable cystoscopes may be preferred based on costs, the authors highlight a range of additional considerations that may justify having disposable ones available at least in parallel. Infection risk from contamination of reusable cystoscopes, although reported, should be infrequent. Most infections following cystoscopy in fact result from the patient's endogenous flora being introduced into the bladder during the procedure. However, in numerous clinical settings where infection control precautions are required 2, the utility of disposable equipment is self-evident. Disposable cystoscopes may also provide a greater degree of portability compared to reusable ones, especially if paired with portable or interchangeable monitors. This can greatly facilitate their use in settings other than the endoscopy suite, such as the Emergency Department, Intensive Care Unit or even inpatient wards, allowing expedient management of scenarios such as difficult catheterisation. In order to best manage the substantial environmental impact of healthcare provision, it should also be an important consideration in decisions such as cystoscope choice. The comparative data on the carbon footprint of disposable vs. reusable cystoscopes is limited and somewhat disparate, but overall appears to favour single-use systems 3. Certainly additional research is needed in this area to guide future decision-making. In the end, the choice between disposable and reusable cystoscopes in any particular institution will come down to a complex integration of the above and other factors. These considerations will have parallels for other systems where the two choices exist, including for example uretero-pyeloscopes, bronchoscopes, colonoscopes and oesophago-gastro-duodenoscopes. Anita Clarke: conceptualization, writing – review and editing. Shomik Sengupta: conceptualization, writing – original draft, writing – review and editing. The authors declare no conflicts of interest. No data included in submission.