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      Cost Comparison of Single-Use Versus Reusable Bronchoscopes Used for Percutaneous Dilatational Tracheostomy

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          Both single-use and reusable bronchoscopes are suitable for percutaneous dilatational tracheostomy (PDT) to visualise the trachea during the insertion process. To determine the least costly option, the price of single-use bronchoscopes must be weighed against the estimated average cost of a bronchoscopy with reusable equipment. In the latter case, the acquisition cost must be spread over the equipment’s useful life and other relevant costs, such as reprocessing and repair, must be included.


          This study aimed to calculate the cost of using single-use or reusable bronchoscopes per PDT procedure.


          A systematic literature search was conducted to identify studies comparing the costs of reusable and single-use bronchoscopes for PDT. Inclusion criteria were articles assessing the cost of single-use or reusable bronchoscopes, and where costs were divided into acquisition, reprocessing, and repair costs. A questionnaire regarding repair rates and costs for reusable bronchoscopes was sent to 366 hospitals in the US, UK, and Germany to supplement the identified literature.


          Eleven studies met the inclusion criteria. Ninety-nine completed responses were received, of which 31 hospitals used reusable equipment for PDT. Literature research revealed an average acquisition cost of $US135 (SD 152) and reprocessing cost of $US123 (SD 128). Additionally, a combination of data from the literature and the questionnaires gave a repair cost per use of $US148 (SD 242), resulting in a total average cost of $US406 for reusable bronchoscopes and $US249 (SD 36) for single-use bronchoscopes per PDT procedure. Thus, the incremental cost per use of a reusable bronchoscope compared with a single-use bronchoscope was $US157.


          We conclude that significant savings can be made by using single-use bronchoscopes to guide PDT in preference to reusable bronchoscopes. Results depend on hospital setting, the reprocessing procedures, annual bronchoscope procedures, individual repair cost, and repair rates.

          Electronic supplementary material

          The online version of this article (10.1007/s41669-018-0091-2) contains supplementary material, which is available to authorized users.

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          Most cited references 19

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          Elective percutaneous dilatational tracheostomy. A new simple bedside procedure; preliminary report.

          The development by the senior author (P.C.) of percutaneous tracheostomy from cricothyroidostomy and subcricoid fingertip tracheostomy is traced, and the technique and patient material of percutaneous subcricoid tracheostomy is presented. This new technique consists of inserting a tracheostomy tube by the use of a J guide wire inserted through a cannula into the tracheal lumen. Tapered dilators follow the guide wire and dilate the opening in the tracheal walls. A tracheostomy tube snugly fitted over a dilator is then passed into the trachea between the cricoid cartilage and the first tracheal ring. This procedure avoids the immediate and postoperative complications of "standard" tracheostomy. An experience of 134 tracheostomies of various types culminated in the development of the percutaneous technique. To date 26 such operations on 24 patients have been done with no significant complications due to the operation. The percutaneous technique should reduce the severity and incidence of intraoperative complications. Late complications, which have been no problem to date, are being evaluated with longer follow-up and with a greater patient population.
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            Economic evaluation for devices and drugs--same or different?

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              Bronchoscopic guidance makes percutaneous tracheostomy a safe, cost-effective, and easy-to-teach procedure.

              We wanted to assess the efficiency of instituting a modified technique of percutaneous tracheostomy (PET) with bronchoscopic guidance. During a 10-month period 48 consecutive trauma patients requiring tracheostomy were divided between a standard tracheostomy control group (ST) and a PET group. All patients were followed prospectively. The hospital charges were reviewed retrospectively. Age, gender, body habitus, and principal diagnosis were similar in the 21 ST patients and the 27 PET patients. All STs and 15 of the PETs were performed in the operating room (OR), and the 12 remaining PETs were done in the intensive care unit (ICU). Four patients in the ST group and six in the PET group died. One of these deaths occurred in a patient in the PET group with severe adult respiratory distress syndrome. Procedure time was shorter for PET (16 versus 45 minutes, p < 0.0001). Junior residents performed more PETs than STs (33% versus 10%), and PET was considered "easier" to perform than ST (81% versus 47%). Hospital charges for PET in the ICU were $3400 less per patient compared with ST or PET in the OR. PET was performed easily and safely in the OR and at the ICU bedside. PET required one-third the time of ST. Bronchoscopic supervision of PET may have contributed to the small number of complications and the educational experience of junior residents. PET in the ICU can reduce hospital charges significantly and avoids transport of patients to the OR. PET is as safe as ST and should be considered the procedure of choice for an ICU patient requiring an elective tracheostomy.

                Author and article information

                [1 ]Ambu A/S, Baltorpbakken 13, 2750 Ballerup, Denmark
                [2 ]Department of Business and Management, Fibigerstraede 11, 9220 Aalborg, Denmark
                [3 ]Department of Health Science and Technology, Frederik Bajers Vej 7, 9220 Aalborg, Denmark
                [4 ]ISNI 0000 0004 0581 2008, GRID grid.451052.7, Wythenshawe Hospital, , Manchester University Hospital NHS Foundation Trust, ; Southmoor Road, Manchester, M23 9LT UK
                Pharmacoecon Open
                Pharmacoecon Open
                PharmacoEconomics Open
                Springer International Publishing (Cham )
                30 August 2018
                30 August 2018
                June 2019
                : 3
                : 2
                : 189-195
                © The Author(s) 2018

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (, which permits any noncommercial use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

                Original Research Article
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                © The Author(s) 2019


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