Cost analysis of single-use (Ambu® aScope™) and reusable bronchoscopes in the ICU

Abstract

BackgroundFlexible optical bronchoscopes are essential for management of airways in ICU, but the conventional reusable flexible scopes have three major drawbacks: high cost of repairs, need for decontamination, and possible transmission of infectious agents. The main objective of this study was to measure the cost of bronchoalveolar lavage (BAL) and percutaneous tracheostomy (PT) using reusable bronchoscopes and single-use bronchoscopes in an ICU of an university hospital. The secondary objective was to compare the satisfaction of healthcare professionals with reusable and single-use bronchoscopes.MethodsThe study was performed between August 2009 and July 2014 in a 16-bed ICU. All BAL and PT procedures were performed by experienced healthcare professionals. Cost analysis was performed considering ICU and hospital organization. Healthcare professional satisfaction with single-use and reusable scopes was determined based on eight factors. Sensitivity analysis was performed by applying discount rates (0, 3, and 5%) and by simulation of six situations based on different assumptions.ResultsAt a discount rate of 3%, the costs per BAL for the two reusable scopes were 188.86€ (scope 1) and 185.94€ (scope 2), and the costs per PT for the reusable scope 1 and scope 2 and single-use scopes were 1613.84€, 410.24€, and 204.49€, respectively. The cost per procedure for the reusable scopes depended on the number of procedures performed, maintenance costs, and decontamination costs. Healthcare professionals were more satisfied with the third-generation single-use Ambu® aScope™.ConclusionsThe cost per procedure for the single-use scope was not superior to that for reusable scopes. The choice of single-use or reusable bronchoscopes in an ICU should consider the frequency of procedures and the number of bronchoscopes needed.Electronic supplementary materialThe online version of this article (doi:10.1186/s13613-016-0228-3) contains supplementary material, which is available to authorized users.

Single‐use flexible bronchoscopes compared with reusable bronchoscopes: Positive organizational impact but a costly solution

“…Previous studies are in agreement with ours as to the cost of single‐use FBs (from €200 to €250). However, due to the high number of bronchoscopies performed per year, for our institution, reusable FBs cost less in comparison with the amounts stated in previous studies (from €177 to €285) . This can be explained by 2 factors.…”

A systematic review and cost effectiveness analysis of reusable vs. single‐use flexible bronchoscopes

“…The other main strength is the fact that this is the first study to identify risk of patient contamination and infection from the published literature. In general, cost analyses lack precision in terms of including all relevant overhead costs [18][19][20]. This is difficult may have a limited impact on our data.…”

“…There are two main strengths of this study, the first being the micro‐costing analysis as the cost comparison between reusable and single‐use equipment is complex. Numerous overhead cost elements must be considered, and this study captures more than previous studies . The other main strength is the fact that this is the first study to identify risk of patient contamination and infection from the published literature.…”

“…In general, cost analyses lack precision in terms of including all relevant overhead costs . This is difficult to manage because numerous elements contribute to the overall cost per use estimate, such as water consumption, electricity, training of new personnel in cleaning techniques, maintaining updated and compliant guidelines on reprocessing, handling of automated endoscope reprocessor cycle failures, among others.…”

“…This is difficult to manage because numerous elements contribute to the overall cost per use estimate, such as water consumption, electricity, training of new personnel in cleaning techniques, maintaining updated and compliant guidelines on reprocessing, handling of automated endoscope reprocessor cycle failures, among others. Moreover, the cost of the tracking systems is often left out . If all relevant indirect and overhead costs were identified and included in those analyses, evidently it would add to the cost per use.…”