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

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          Summary

          The cost effectiveness of reusable vs. single‐use flexible bronchoscopy in the peri‐operative setting has yet to be determined. We therefore aimed to determine this and hypothesised that single‐use flexible bronchoscopes are cost effective compared with reusable flexible bronchoscopes. We conducted a systematic review of the literature, seeking all reports of cross‐contamination or infection following reusable bronchoscope use in any clinical setting. We calculated the incidence of these outcomes and then determined the cost per patient of treating clinical consequences of bronchoscope‐induced infection. We also performed a micro‐costing analysis to quantify the economics of reusable flexible bronchoscopes in the peri‐operative setting from a high‐throughput tertiary centre. This produced an accurate estimate of the cost per use of reusable flexible bronchoscopes. We then performed a cost effectiveness analysis, combining the data obtained from the systematic review and micro‐costing analysis. We included 16 studies, with a reported incidence of cross‐contamination or infection of 2.8%. In the micro‐costing analysis, the total cost per use of a reusable flexible bronchoscope was calculated to be £249 sterling. The cost per use of a single‐use flexible bronchoscope was £220 sterling. The cost effectiveness analysis demonstrated that reusable flexible bronchoscopes have a cost per patient use of £511 sterling due to the costs of treatment of infection. The findings from this study suggest benefits from the use of single‐use flexible bronchoscopes in terms of cost effectiveness, cross‐contamination and resource utilisation.

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          Most cited references64

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          Model parameter estimation and uncertainty analysis: a report of the ISPOR-SMDM Modeling Good Research Practices Task Force Working Group-6.

          A model's purpose is to inform medical decisions and health care resource allocation. Modelers employ quantitative methods to structure the clinical, epidemiological, and economic evidence base and gain qualitative insight to assist decision makers in making better decisions. From a policy perspective, the value of a model-based analysis lies not simply in its ability to generate a precise point estimate for a specific outcome but also in the systematic examination and responsible reporting of uncertainty surrounding this outcome and the ultimate decision being addressed. Different concepts relating to uncertainty in decision modeling are explored. Stochastic (first-order) uncertainty is distinguished from both parameter (second-order) uncertainty and from heterogeneity, with structural uncertainty relating to the model itself forming another level of uncertainty to consider. The article argues that the estimation of point estimates and uncertainty in parameters is part of a single process and explores the link between parameter uncertainty through to decision uncertainty and the relationship to value-of-information analysis. The article also makes extensive recommendations around the reporting of uncertainty, both in terms of deterministic sensitivity analysis techniques and probabilistic methods. Expected value of perfect information is argued to be the most appropriate presentational technique, alongside cost-effectiveness acceptability curves, for representing decision uncertainty from probabilistic analysis.
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            Transmission of infection by flexible gastrointestinal endoscopy and bronchoscopy.

            Flexible endoscopy is a widely used diagnostic and therapeutic procedure. Contaminated endoscopes are the medical devices frequently associated with outbreaks of health care-associated infections. Accurate reprocessing of flexible endoscopes involves cleaning and high-level disinfection followed by rinsing and drying before storage. Most contemporary flexible endoscopes cannot be heat sterilized and are designed with multiple channels, which are difficult to clean and disinfect. The ability of bacteria to form biofilms on the inner channel surfaces can contribute to failure of the decontamination process. Implementation of microbiological surveillance of endoscope reprocessing is appropriate to detect early colonization and biofilm formation in the endoscope and to prevent contamination and infection in patients after endoscopic procedures. This review presents an overview of the infections and cross-contaminations related to flexible gastrointestinal endoscopy and bronchoscopy and illustrates the impact of biofilm on endoscope reprocessing and postendoscopic infection.
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              Hospital-related cost of sepsis: A systematic review

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                Author and article information

                Contributors
                Role: Student
                Role: Professor
                Role: Clinical Microbiologist/Clinical Pathologist
                Role: Consultant/Honorary Senior Lecturer
                Role: Consultant/Honorary Senior Lecturerelboghdadly@gmail.com , https://twitter.com/elboghdadly , https://twitter.com/dr_imranahmad
                Journal
                Anaesthesia
                Anaesthesia
                10.1111/(ISSN)1365-2044
                ANAE
                Anaesthesia
                John Wiley and Sons Inc. (Hoboken )
                0003-2409
                1365-2044
                08 November 2019
                April 2020
                : 75
                : 4 ( doiID: 10.1111/anae.v75.4 )
                : 529-540
                Affiliations
                [ 1 ] Department of Health Science and Technology Faculty of Medicine Aalborg University Aalborg Denmark
                [ 2 ] Danish Center of Healthcare Improvements Institute of Business and Management Aalborg University Aalborg Denmark
                [ 3 ] Sint‐Jozefkliniek Bornem and Willebroek Bornem Belgium
                [ 4 ] Guy's and St. Thomas’ NHS Foundation Trust London UK
                [ 5 ] King's College London UK
                Author notes
                [*] [* ] Correspondence to: K. El‐Boghdadly

                Email: elboghdadly@ 123456gmail.com

                Article
                ANAE14891
                10.1111/anae.14891
                7079200
                31701521
                5dbd0d2a-9bc3-4ff6-8b18-65622c3d4b79
                © 2019 The Authors. Anaesthesia published by John Wiley & Sons Ltd on behalf of Association of Anaesthetists

                This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.

                History
                : 19 September 2019
                Page count
                Figures: 4, Tables: 3, Pages: 12, Words: 7921
                Categories
                Review Article
                Review Articles
                Custom metadata
                2.0
                April 2020
                Converter:WILEY_ML3GV2_TO_JATSPMC version:5.7.8 mode:remove_FC converted:18.03.2020

                Anesthesiology & Pain management
                airway management,bronchoscope,economics,infection,intubation
                Anesthesiology & Pain management
                airway management, bronchoscope, economics, infection, intubation

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