title: Cost analysis of single-use (Ambu®aScope™) and reusable bronchoscopes in the ICU.
abstract: BACKGROUND
  Flexible 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.
  
  
  METHODS
  The 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.
  
  
  RESULTS
  At 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™.
  
  
  CONCLUSIONS
  The 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.
authors.affiliation: Réanimation Adultes & USC, Pôle de Médecine Péri-Opératoire, CHU Clermont-Ferrand, Clermont-Ferrand, France. sperbet@chu-clermontferrand.fr.|R2D2, EA 7281, Faculté de Médecine, Université d'Auvergne, Clermont-Ferrand, France. sperbet@chu-clermontferrand.fr.|Réanimation Médico-Chirugicale, Pôle de Médecine Péri-Opératoire, Hôpital Gabriel-Montpied, CHU Clermont-Ferrand, 58 Rue Montalembert, 63000, Clermont-Ferrand Cedex, France. sperbet@chu-clermontferrand.fr.
authors.forename: S
authors.initials: S
authors.lastname: Perbet
authors.affiliation: Service de Santé Publique, CHU Clermont-Ferrand, 7, Place Henri-Dunant, 63058, Clermont-Ferrand Cedex 1, France.|Clermont Université, Université d'Auvergne, EA 4681, PEPRADE (Périnatalité, grossesse, Environnement, PRAtiques médicales et DEveloppement), Clermont-Ferrand, France.
authors.forename: M
authors.initials: M
authors.lastname: Blanquet
authors.affiliation: Service de Santé Publique, CHU Clermont-Ferrand, 7, Place Henri-Dunant, 63058, Clermont-Ferrand Cedex 1, France.|Clermont Université, Université d'Auvergne, EA 4681, PEPRADE (Périnatalité, grossesse, Environnement, PRAtiques médicales et DEveloppement), Clermont-Ferrand, France.
authors.forename: C
authors.initials: C
authors.lastname: Mourgues
authors.affiliation: Réanimation Adultes & USC, Pôle de Médecine Péri-Opératoire, CHU Clermont-Ferrand, Clermont-Ferrand, France.
authors.forename: J
authors.initials: J
authors.lastname: Delmas
authors.affiliation: Réanimation Adultes & USC, Pôle de Médecine Péri-Opératoire, CHU Clermont-Ferrand, Clermont-Ferrand, France.
authors.forename: S
authors.initials: S
authors.lastname: Bertran
authors.affiliation: Réanimation Adultes & USC, Pôle de Médecine Péri-Opératoire, CHU Clermont-Ferrand, Clermont-Ferrand, France.
authors.forename: B
authors.initials: B
authors.lastname: Longère
authors.affiliation: Pharmacie centrale, Centrale d'Approvisionnement de Matériel Stérile, CHU Clermont-Ferrand, Clermont-Ferrand, France.
authors.forename: V
authors.initials: V
authors.lastname: Boïko-Alaux
authors.affiliation: Pharmacie centrale, Centrale d'Approvisionnement de Matériel Stérile, CHU Clermont-Ferrand, Clermont-Ferrand, France.
authors.forename: P
authors.initials: P
authors.lastname: Chennell
authors.affiliation: Réanimation Adultes & USC, Pôle de Médecine Péri-Opératoire, CHU Clermont-Ferrand, Clermont-Ferrand, France.
authors.forename: J-E
authors.initials: JE
authors.lastname: Bazin
authors.affiliation: Réanimation Adultes & USC, Pôle de Médecine Péri-Opératoire, CHU Clermont-Ferrand, Clermont-Ferrand, France.|R2D2, EA 7281, Faculté de Médecine, Université d'Auvergne, Clermont-Ferrand, France.
authors.forename: J-M
authors.initials: JM
authors.lastname: Constantin
keywords: Airway management; Fiberscope; Medico-economic analysis; Percutaneous tracheostomy; Single use