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

Anders E Kristensen; Jonathan S Kurman; D K Hogarth; Sonali Sethi; Sabrina S Sørensen

doi:10.1007/s41669-023-00417-y

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

Pharmacoecon Open. 2023 Jul;7(4):665-678. doi: 10.1007/s41669-023-00417-y. Epub 2023 May 15.

Authors

Anders E Kristensen¹, Jonathan S Kurman², D K Hogarth³, Sonali Sethi⁴, Sabrina S Sørensen⁵

Affiliations

¹ School of Medicine and Health, Aalborg University, Aalborg, Denmark. [email protected].
² Division of Pulmonary and Critical Care, Medical College of Wisconsin, Milwaukee, WI, USA.
³ Section of Pulmonary and Critical Care Medicine/Interventional Pulmonology, Department of Medicine, The University of Chicago, Chicago, IL, USA.
⁴ Interventional Pulmonology, Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA.
⁵ Danish Center for Healthcare Improvements, Department of Clinical Medicine, Aalborg University, Aalborg Oest, Denmark.

Abstract

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.