All the steps in the life cycle of a reusable endoscope, from its use, reprocessing, transport through to its repair, are additional items in the long list of expenditure required to maintain these systems.
In order to make an objective comparison, it is necessary to not only cover the direct financial aspects, but to also extend the comparison to all direct and indirect costs:
Cost per use of reusable bronchoscope = 294€ (1)
For each repair, the endoscope is unavailable for a long period; no repairs can be performed on-site in the hospital. Hospitals usually have costly maintenance contracts with manufacturers.
This aspect should not be overlooked when comparing single-use and reusable devices.(2)
Average cost per repair
Use / repair ratio
Average cost per use
These data are a summary from 14 different American institutions and help estimate the real induced costs in terms of equipment, personnel and immobilization time to perform the processes in accordance with the guidelines. Although the study appears to be very detailed, the authors conclude that additional research is necessary in order to gain a better knowledge of the costs, particularly those related to maintenance.(3)
Average time = 76 min
|Reprocessing step||Minimum cost||Maximum cost|
|PPE for reprocessing personel||$5.06||$17.78|
|Visual inspection, cleaning verification, and re-cleaning 20% endoscopes||$14.62||$49.69|
|HLD in an AER||$10.74||$17.21|
|Drying and storage||$1.88||$6.45|
|Repairs needed use due to issues identified by reprocessing technicians||$63.93||$128.05|
Risk of residual
cross-contamination after decontamination of a bronchoscope following the guidellness
Risk of patient developing an infection following the use of a contaminateds reusable broncoscope
Additional cost of treatment per patient having contracted VAP
When the risk of developing VAP in a ventilated patient is multiplied by the risk of residual contamination of an endoscope, an infection risk of 0.007% per procedure is obtained. This risk related to the cost of treating VAP leads to an estimated cost of $178 per procedure for the treatment of cross-contamination according to this study.(4)
major events related to
deaths were counted related
to airway managment,
including 16 in the operating room,
2 in emergency departments
and 18 in intensive care/resuscitation
The mortality rate related to the number of patients included in the study is 58 times higher in intensive care/resuscitation settings than in the operating room.
In the report, to explain this difference, it was mentioned that accessing to a fiber-optic endoscope for inspection of the airways or in the event of a difficult intubation were recurrents problems, as the personnel training was in the technique.
The authors recommend that a fiber-optic endoscope be immediately available and ready to use in intensive care/resuscitation or emergency departments. Personnel should also be better trained in the use of the different devices, including fiber-optic endoscopes, in the event of difficult intubation.
Single-use endoscopes obviate the need for lengthy and costly reprocessing and repair steps. They are always available and sterile and can be easily stored on an emergency intubation cart.(5)
With our calculator, make an evaluation of the cost-saving aspects
of converting to single-use endoscopes in your hospital.
References to read:
(1) Mouritsen et al. A systematic review and cost effectiveness analysis of reusable vs. single-use bronchoscopes . Anaesthesia, 75: 529-540. https://doi.org/10.1111/anae.14891
(2) High Price of Bronchoscopy – Cost of Maintenance and Repair of Flexible and Ultra-sound Bronchoscopes
(3) A glimpse at the true cost of reprocessing endoscopes: results of a pilot project
(4) Terjesen et al. 2017; Early Assessmen of the Likely Cost Effectiveness of Single-Use Flexible Video Bronchoscopes
(5) NAP4 – 4th National Audit Project of The Royal College of Anaesthetists and The Difficult Airway Society.