First, do no harm? A framework for evaluating new versus reprocessed medical devices

More than ever before, health care providers are under intense pressure to control costs. Medical devices represent a significant ‘hard’ cost, with worldwide spending exceeding USD 235 billion. A growing number of health care providers are engaging in the practice of reprocessing–sterilizing and reusing medical devices labelled only for a single use. The ethical and technical dimensions of this practice have received much attention, but its economic aspects remain largely unexamined. This paper presents a Markov decision process framework that a health care provider can use to decide whether to use new or reprocessed devices in a given context. Two cases are studied: completely observable device condition and partially observable device condition. After briefly discussing structural results for the two cases, several examples are presented to illustrate how the model can be applied in practice. Useful results can be computed quickly with minimal data. A key insight of the model is that perfect information regarding the device condition is often not required to make a sound decision.