The Economics of Cystoscopy: A Microcost Analysis

Abstract

Objective: To evaluate the per-procedure cost of flexible cystoscopy in relation to reimbursement.

Materials and methods: Capital, maintenance, reprocessing, labor, and disposable costs were calculated at a high-volume academic institution over the fiscal year 2019. Five-year amortized values were used to calculate reusable cystoscope and automated endoscopic reprocessor (AER) per-procedure cost. Twenty flexible cystoscope procedure cycles were timed and multiplied by prevailing medical office assistant wages to determine labor costs. Medicare and commercially insured reimbursements were queried to evaluate the cost and profitability of cystoscopy.

Results: In total, 3739 flexible cystoscopies were performed with 415 procedures per cystoscope. Total annual costs for capital and maintenance, reprocessing, labor, and disposable supplies was $202,494, $147,969, $128,117, and $121,904, respectively. The per-procedure cost for reusable cystoscopy with AER reprocessing, reusable cystoscopy with a high-level disinfectant (HLD), and theoretical costs of disposable cystoscopy were calculated to be $161, $133, and $222, respectively. The volume of procedures per scope had a significant impact on cost and profitability. The number of procedures per cystoscope performed to have equivalent cost as a disposable scope was, 196 and 145 cystoscopies per cystoscope per year, for AER and HLD-reprocessed cystoscopes, respectively.

Conclusions: There is a considerable contribution of capital equipment, maintenance, labor, and supplies to the cost of cystoscopy with profitability highly depend on the volume of cystoscopies performed for each cystoscope. The use of AER results in higher cost than HLD. Cost-effectiveness of disposable scopes needs to be determined but will vary by clinic volume and site of practice.