The Cost of Flexible Bronchoscopes: A Systematic Review and Meta-analysis

A Micro-costing Analysis of Single-use and Reusable Flexible Bronchoscope Usage in the Bronchoscopy Service at A Tertiary Care University Hospital

BACKGROUND

Single-use flexible bronchoscopes (SFBs) are increasingly used to minimize cross-infection risk, particularly in immunocompromised and intensive care unit patients. However, broader adoption requires cost analysis. We conducted a 1-year cost-minimization analysis comparing SFBs and reusable flexible bronchoscopes (RFBs) at a tertiary care university hospital.

METHODS

We evaluated the costs per procedure, considering capital equipment, maintenance, repair, reprocessing, and overhead costs. We also analyzed the impact of annual procedure volume on costs and performed a sensitivity analysis to assess the effect of uncertainty on costs.

RESULTS

A total of 1394 bronchoscopies were performed. RFBs were less expensive for an annual volume of >50 bronchoscopies/year, with a 22% lower cost per procedure than that for SFBs (€203 vs. €259). This cost advantage became increasingly favorable with an increasing number of procedures, reaching a plateau after exceeding 250 bronchoscopies/year. The capital equipment, the annual number of bronchoscopies, and reprocessing were the major cost drivers for RFBs. During nonworking hours, the cost per procedure of RFBs ranged from €349.45 to €392.29. Using RFBs during interventions involving a high risk of bronchoscope damage (frequency of damage >10%) would increase the cost per bronchoscopy to >€263 (exceeding the cost of SFBs).

CONCLUSION

RFBs were 22% less expensive than SFBs for services with a moderate to high volume of bronchoscopies. However, this difference could not justify using RFBs in patients with a high cross-infection risk. SFBs might be less costly for procedures outside working hours and interventions involving a high risk of bronchoscope damage.

Technological advances in single-use or disposable bronchoscopy: an evaluation of the Innovative Ambu® aScope™ 5 in a quaternary referral bronchoscopy unit

Background

Single-use flexible bronchoscopes (SUFBs) offer various advantages over reusable bronchoscopes (RBs) including portability and cost-effectiveness, and potentially reduced infection transmission. Our study aimed to review the performance of the Ambu® aScope™ 5 Broncho suite in Cork University Hospital.

Methods

Following ethical approval, data was collected prospectively on procedures performed with the Ambu® aScope™ 5 in Cork University Hospital. Data included patient demographics, procedure details (location, indication, SUFB size, procedures, complications), and user satisfaction and demographics.

Results

There were 98 procedures performed with the Ambu® aScope™ 5, all in the endoscopy suite. There were 42 female patients (42.9%) and 56 male (57.1%). Various sized models were used-2.7/1.2 (n=3), 4.2/2.2 (n=4), 5/2.2 (n=60), 5.6/2.8 (n=31). Infection was the most common indication while others included malignancy, haemoptysis, sarcoidosis, and asthma. The most commonly performed procedure was airway inspection (n=98), while bronchoalveolar lavage (BAL) (n=84), brushings (n=3), endobronchial biopsies (n=5), transbronchial needle aspiration (TBNA) (n=1), and argon plasma coagulation (APC) (n=1) were among others. The average user satisfaction rating (from one to five in ascending order of satisfaction) was 4.8 [5 (n=85), 4 (n=9), 3 (n=1), 2 (n=3), 1 (n=0)]. The most common reason for user dissatisfaction was related to suction (n=3). Conversion from single-use to RB was not required in any case. There were no bronchoscope-related patient complications.

Conclusions

Within this cohort of patients, the Ambu® aScope™ 5 was both safe and versatile with a high level of user satisfaction.

Costs involved in compliance with new endoscope reprocessing guidelines

BACKGROUND/AIMS

In March 2022, the Association for the Advancement of Medical Instrumentation (AAMI) released the American National Standards Institute (ANSI)/AAMI ST91:2021, their latest update on comprehensive, flexible, and semirigid endoscope reprocessing. These updated standards recommend the sterilization of high-risk endoscopes when possible and provide new recommendations for the precleaning, leak testing, manual cleaning, visual inspection, automated reprocessing, drying, storage, and transport of endoscopes.

METHODS

ANSI/AAMI ST91:2021 was compared with ANSI/AAMI ST91:2015 for major reprocessing differences that result in either time and/or cost increases. Time estimates were captured by explicit recommendation inclusion or taken from the literature. All the costs were estimated using publicly available resources.

RESULTS

The updated standards represent a potential 24.3-minute and 52.35 to 67.57 United States dollars increase per procedure in terms of reprocessing time and spending, respectively, not including capital investments. Capital costs per procedure were highly dependent on the procedure volume of the facility.

CONCLUSIONS

The new AAMI standards recommend several major changes, such as sterilization, for facilities to reprocess and manage endoscopes between uses. As more facilities increase their reprocessing methods to reflect the updated standards, they do so at a cost and introduce several delays. As the reprocessing landscape evolves, facilities should consider their true costs and alternative solutions, such as single-use endoscopes.

Single-use flexible bronchoscopes vs traditional reusable flexible bronchoscopes: a prospective controlled study

BACKGROUND

Single-use flexible bronchoscopes(SFB) eliminate the risk of bronchoscopy-related infection compared with traditional reusable flexible bronchoscopes(RFB). At present, there is no comparative study between SFB and RFB in the aspects of biopsy and interventional therapy. This study aims to explore whether SFB can perform complex bronchoscopic procedures such as transbronchial biopsies just like RFB.

METHODS

We conducted a prospective controlled study. A total of 45 patients who required bronchoscopic biopsy in our hospital from June 2022 to December 2022 were enrolled. The patients were divided into the SFB group and the RFB group, and routine bronchoscopy, bronchoalveolar lavage, and biopsy were performed respectively. Data on the time of routine bronchoscopy, the recovery rate of bronchoalveolar lavage fluid(BALF), biopsy time, and bleeding volume were collected. Then we used the two-sample t-test and the χ² test to assess the performance differences between SFB and RFB. We also designed a questionnaire to compare the performance between SFB and RFB by different bronchoscope operators.

RESULTS

The routine examination time of SFB and RFB was 3.40 ± 0.50 min and 3.55 ± 0.42 min, respectively. There was no significant difference between the two groups (P = 0.308). The recovery rate of BALF was (46.56 ± 8.22) % in the SFB group and (47.00 ± 8.07) in the RFB group, without a significant difference between the two groups(P = 0.863). The biopsy time was similar(4.67 ± 0.51 min VS 4.57 ± 0.45 min) in both groups, with no significant difference(P = 0.512). The positive biopsy rate was 100% in both groups, with no significant difference. Overall, the bronchoscope operators were generally satisfied with SFB.

CONCLUSION

SFBs are non-inferior to RFBs in routine bronchoscopy, bronchoalveolar lavage, and biopsy. It is suggested that SFBs have a wider clinical application.

Systematic Review and Cost-Consequence Analysis of Ambu aScope 5 Broncho Compared with Reusable Flexible Bronchoscopes: Insights from Two US University Hospitals and an Academic Institution

OBJECTIVE

The aim of this study was to perform a systematic review, meta-analysis and cost-consequence analysis of the single-use bronchoscope, Ambu aScope^TM 5 Broncho, in relation to reusable flexible bronchoscopes (RFB) available within three high procedure volume university hospitals and academic institutions in the USA.

METHODS

The primary outcome was incremental cost and the secondary outcome was incremental cross-infection risk of use for both the single-use flexible bronchoscope (SUFB) and RFBs. Cost estimates included capital, repair, and reprocessing costs derived from a prospective observational micro-costing approach within three large university hospitals and academic institutions. All costs were valued in 2022 US dollars (USD). A meta-analysis based on literature covering cross-contamination and infection from 2010 to 2020 investigated cross-infection risk following bronchoscopy procedures with RFBs. Capital costs were discounted at 3% over 5-8 years. All parameters were evaluated using both univariate deterministic and probabilistic sensitivity analyses.

RESULTS

In high-volume hospitals, RFBs were cost minimizing compared to SUFBs. Probabilistic sensitivity analysis showed that RFBs were cost saving in 88% of iterations. Univariate analyses illustrated sensitivity of the base-case result to the procedure volume. Data from sensitivity analyses suggest that the two interventions are cost neutral at a break-even point of 756 procedures per year or 46 procedures per bronchoscope per year.

CONCLUSION

Assuming equivalent clinical performance, single-use flexible bronchoscopes are not cost minimizing when including the costs associated with cross-infection in high-volume US university hospitals and academic institutions. Overall, the benefits of conversion from RFBs to SUFBs are dependent on the annual procedure volume of individual hospitals, expected cross-infection risk, and purchase price of the aScope 5 Broncho.

Management and outcome of obstructive airway complications after lung transplantation - a 12-year retrospective cohort study

BACKGROUND

Obstructive airway complications (OACs) represent a significant problem after lung transplantation (LTx). Bilateral OACs after double lung transplantation are infrequently reported.

OBJECTIVES

The aim of this study was to investigate management and outcome of OAC.

DESIGN

Retrospective single-center cohort study.

METHODS

Adult patients with bilateral LTx performed between 2010 and 2021 were included. Patients with follow-ups of less than 3 months and after heart-lung transplantation were excluded. OAC was defined either as the need for stenting, surgical revision, or balloon dilatation. Outcome parameters included graft survival, graft function, quality of life, and management.

RESULTS

During the study period, 1,170 patients were included. Hundred thirty-five (11.5%) patients developed OAC. Forty-six (4.4%) patients had significant bilateral OAC. Thirty-seven (80%) bilateral OAC patients were treated by stent insertion; in 34 patients, biodegradable stents were used. The median number of bronchoscopies in bilateral OAC was 26 during the first postoperative year compared with nine in controls (p < 0.001). Fourteen OAC patients (n = 10 bilateral) underwent surgical revision including six re-do transplantations. Graft loss occurred significantly more frequently in patients with bilateral OAC with a graft survival of 63% and 50% in these after 3 and 5 years compared with 83% and 73% in controls without OAC (p < 0.001). Baseline forced expiratory volume in 1 s (FEV1) in patients with bilateral OAC was median 58% predicted in comparison with 90% in controls (p < 0.001). Quality of life was significantly reduced.

CONCLUSION

Bilateral OACs impose a high burden of disease on patients after lung transplantation and were associated with early and late graft loss. Affected patients' OAC demonstrated reduced graft function and impaired quality of life. Most OACs were managed by bronchoscopy preferably by non-permanent stenting. Surgery including re-do transplantation was used in selected cases.