Cost Identification Analysis of Anesthesia Fiberscope Use for Tracheal Intubation

Abstract

Flexible fiberoptic bronchoscopes (fiberscopes) are often used by anesthesiologists to manage patients with difficult airwaysor for confirmation of proper placement of adouble lumen endotracheal tube. The goal of this study was to determine the incremental cost per patient use, from the hospital’s perspective, of a reusable fiberscope for tracheal intubation. Methods The fiberscope cost per-use equaled the sum of: 1) annual depreciated capital acquisition cost for the fiberscopes utilized divided by the corresponding number of uses during the study year (10/1/2009 to 10/1/2010), 2) the total annual repair/replacement costs due to fiberscope damage during the study year also divided by the corresponding number of uses during the year, and 3) the incremental costs of cleaning supplies and labor required each time a fiberscope was used.Fixed overhead costs (e.g., hospital endoscope cleaning machinery) independent of the frequency of fiberscope use were not included in thiseconomic analysis. Results 1,132 fiberscope uses occurred in the 12 months. 14fiberscopes were damaged as diagnosed by a leak test and were replaced by the vendor, foran annualrepair/replacement rate of 1.2% (1 in 81 fiberscope uses). The total cost per fiberscope use equaled $94.95 (range $89.80 - $98.39), which is the sum of $13.75device acquisition (ranging from $8.60 to $17.19 depending on 4 to 8 years of fiberscope lifespan amortization), $13.12 for technician labor, $4.76 for consumables towardsfiberscope cleaning and processing, and $63.32 for fiberscope repairs and replacements. Conclusions Repair/replacement costs were the major contributor to the total incremental costs of utilizing reusable fiberscopes in an academic anesthesia department.These results may vary at other hospitals due to differences in purchase and repair arrangements with vendors, clinical practice and fiberscope use, and frequency of damage. When making purchase decisions on these devices, costs downstream from the initial capital monetary outlay need to be assessed.