Von Eiff study on cost-benefit analysis of reusable surgical gowns

Von Eiff study on cost-benefit analysis of reusable surgical gowns

information Service
april 09
How do the costs
of disposable
and reusable
surgical drapes
and gowns
compare ?
Prof. Dr. Wilfried von Eiff.
Hospital Management at
the University of Muenster.
In the German national health system, as
elsewhere, there are seemingly contradictory
pressures to reduce costs while raising medical standards. A recent study
by the University of Münster’s CHM has shown that most German hospital
mangers tended to make their procurement decisions based solely on
purchase price. The general opinion is that while reusable products are
considered to be environmentally friendly and of high quality, disposables
are thought to save time in surgery and to cost less.
Operating theatre textiles belong to a group of textiles known as ‘application
sensitive medical products’ as they come into contact with patients and
can constitute a potential user risk. Price should only be used as a decisive
reason for procurement if comparing identical products.
Economic aspects
The CHM study analysed the economic implications of choosing disposable
or reusable. It showed that the commercial options have completely different
outcomes.
Both disposables and reusables are available as standard quality and high
quality products. Their use depends on the type of operation being carried
out. Cotton drapes and gowns have been discontinued due to the absence
of bacterial barrier properties.
Basic Functionality
Price
Additional Product
Disposal Costs
Total Cost Gap
Functionality
Comfort
Risk Minimisation
Barrier Properties
Mechanical Durability
Quality Gap
During the tender process, prices are usually based on sets ( drapes and
gowns ) and the vital aspect of the precise contents of these and their
quality are ignored. Considerations based purely on unit cost are often
seen to be flawed in retrospect.
Functional defects in surgical gowns, and drapes in particular, can generate
additional costs due to additional consumption of materials or even hospitalacquired infections. As a comparison of products of identical contents
and quality from different manufacturers is seldom possible, a unit cost
comparison is rarely an accurate one.
Taking account of the hospital procedure
Working out which costs are relevant to the choice between disposables
and reusables involves looking at their entire journey to and through the
hospital. This involves everything from whether or not the hospital collects
the goods, through hospital storage policy, internal delivery, and disposal,
which includes waste disposal or collection by the reusables supplier. The
progress, products and compliance with regulations must be monitored
throughout the procedure.
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Comparing like with like
The CHM study looked at four different types of operation in selected clinics.
The type of operation which was finally chosen was a total hip endoprosthesis
procedure, as a relatively large amount of fluid is released during this and
the drape is exposed to intense mechanical stress. The study considered
the best case scenarios often used in tenders and worst case scenarios, and
discarded both as atypical of real world situations.
Disposables lower material density makes them harder to attach to patients
than reusables. The study showed that this could take an extra 4 minutes,
costing an additional € 32 in theatre time.
There are significant differences in the contents of hip sets from different
providers and, with disposables in particular, extra components often had
to be added to standardise the sets. For instance, preparing extra drapes
incurs an average delay of two minutes at a cost of € 16, based on theatre
time costs of € 8 per minute.
The more complex the operation, the more advisable it is to use high
performance products and the greater are the savings made over reusable
products.
There are other problems encountered with disposables. The first is their
tendency to tear and crack. The other is that in complex operations which
release large volumes of fluid, reusables absorb more than disposables.
Using disposables means that much of this fluid trickles down onto the
However, the hidden costs in both revealed that disposables’ inferior quality operating room floor, requiring additional cleaning and decontamination
could generate additional costs because of the extra material needed for
afterwards. Finally, low cost disposables also tend to shed more particles
procedures and the cost of additional theatre time.
than reusables which again raise cleaning and maintenance costs.
Prozessstufen einer Hüft-TEP
Bereitstellung
OP-Material
Handdesinfektion
Anlegen der
Schutzbekleidung
Herrichten der OPSiebe und Tische
Reinigung des
Operationssaala
Positionierung
des Patienten
Desinfektion
des Patienten
Abdecken
des Patienten
Schnitt
OP
Naht
Entfernung der
Abdeckungen
Dokumentation
des Eingriffes
Anesthesievorbereitung
des Patienten
Scheiden des bogenförmigen Zugangs
Total cost accounting
If the entire hip endoprosthesis operation runs smoothly, reusables cost
the clinics in the study € 36.64, where as disposables cost € 37.98. These
costs included purchase price, courier service and disposal. Discounting
the worst case scenarios where the unplanned costs for disposable drapes
Mehrweg
Inhalte
verstärkter Instrumentierschutz
Beistelltischabdeckung
U-Tuch
Abdecktücher
OP-Tape
Handtücher
Stockinette
Standard OP-Mantel
High Performance OP-Mantel
Größe
Anzahl
Größe
2
1
1
1
1
1
2
2
79x160
147x200
230x250
281x167
146x180
mittel
-
1
1
1
1
1
1
1
3
4
2
2
77x145
150x190
200x260
175x300
150x190
90x150
75x90
9x49
19x25
-
Gegenüberstellung der Materialien für eine Hüft-TEP aus Setbeispielen
Entfernung des
Knochenmaterials
Einsetzen der
Prothese
Schliessen
der Wunde
amounted to 180 % of the cost of reusable drapes, the study found that
additional costs of € 1.36 for reusables and € 12 for disposables can be
assumed. This saving of at least € 10 compared with each disposable set
makes reusables an attractive proposition.
Kosten pro Hüft-TEP
Einweg
Anzahl
-
Verlegung des
Patienten
-
120
100
80
60
40
20
Einweg
0
Mehrweg
Best Case
Regelfall
Worst Case
Kostenvergleich bzgl .der Hüft-TEP
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Je komplexer der Eingriff, desto eher ist die Verwendung von High-Performance-Produkten
anzuraten und desto höher sind die Kostenvorteile bei Mehrwegprodukten.
Mehrwegprodukte bieten sowohl für Standard Performance als auch für den
High-Performance-Bereich funktionelle Material- und Komponentenlösungen.
Standard Performance
High Performance
Mechanical
Stress
Additional Costs for
SU-Drapes & Gowns
Range of Application for
Reusable Laminate Products
Degree of dynamics
and fluid-exposure
during surgical
procedure
Range of
Application for
Reusable microfilament
Products
Degree of
Fluid-Exposure
Inguinal
Strumectomy
Hip-
Knee- Cardio Surgery
Results of the CHM Study :
Disposables are perceived to be cheap and have reasonable quality. Reusables are seen as more expensive
and of good quality. Neither view is completely accurate.
• Reusable operating theatre textiles achieve a level of utility, manageability and standby costs which only very few
high-performance disposables can match.
• Those high-performance disposables which can match the performance of reusables are usually more expensive
than reusables.
• Reusables are preferable in terms of tensile strength, liquid absorption and bacterial barrier protection.
• Lower grade disposables are preferred by hospitals whose purchasing policy is based on price alone.
They cannot be compared with reusables as far as quality is concerned.
• The market for sets will continue to grow. Providers of reusables could respond to requests from hospitals if
they offered sets suited to each hospital’s specific requirements.