ArticleEinstein (Sao Paulo, Brazil)2026
Rigid cystoscopy versus flexible outpatient cystoscopy: the economic cost behind the epidemiological and social impact.
Article in Einstein (Sao Paulo, Brazil), 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
introductionThe Brazilian Public Health System predominantly performs cystoscopy in hospitals using rigid cystoscopes in operating room settings. This approach results in high operational costs and scheduling delays associated with hospital admission and preoperative protocols. Flexible cystoscopy can be performed in an outpatient setting and may substantially reduce both costs and waiting times.
objectiveTo compare the costs and waiting times associated with rigid and flexible cystoscopy in São Paulo, Brazil.
methodsA retrospective review at a municipal hospital in Brazil identified patients who underwent diagnostic rigid cystoscopy. The analysis estimated the cost of the procedure and the time from indication to examination. Because no public hospital performed flexible cystoscopy during the study period, fees from private hospitals were collected as a proxy and incorporated into a one-way sensitivity analysis.
resultsThe mean cost per rigid cystoscopy reached BRL 8,319.45 (US$1,618.82), ranging from BRL 6,187.10 (US$1,203.90) to BRL 10,512.34 (US$2,045.52). Costs were higher when biopsy occurred (mean BRL 9,744.20) and lower when biopsy was not performed (mean BRL 6,609.75). Fees for flexible cystoscopy ranged from BRL 1,523.81 (US$296.51) to BRL 2,300.00 (US$447.54), with a mean value of BRL 1,800.60 (US$350.37). The mean interval from indication to procedure was 55.64 days for rigid cystoscopy compared with 6.34 days in centers that perform flexible cystoscopy. In sensitivity analysis, even when public-sector flexible cystoscopy costs reached 1.5-3.0× the private fee (BRL 2,701-5,402), the procedure remained approximately 35-68% less expensive than rigid cystoscopy.
conclusionManagement of bladder cancer imposes a substantial economic burden on Brazilian Public Health System. Despite the asymmetry between public and private data sources, these findings support adoption of outpatient flexible cystoscopy to accelerate diagnosis and reduce costs, with important implications for health policy.
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