Cost analysis of single-use versus reusable bronchoscopes in German intensive care units

Bedside bronchoscopy is widely used in intensive care units (ICUs) for a variety of diagnostic and therapeutic procedures. Single-use flexible bronchoscopes (SFB) have emerged as an increasingly utilized alternative to reusable flexible bronchoscopes (RFB), eliminating costs related to device repairs, reprocessing, and routine microbiological surveillance. Beyond clinical outcome parameters, economic and organizational factors as well as aspects of patient safety, including the availability of diagnostic procedures and infection prevention considerations, play an important role in the choice between RSB and SFB.

Using a cost-minimization approach, we compared the costs associated with RFB and SFB during a two-year study period in a German tertiary care hospital with two surgical and two non-surgical ICUs, identifying key cost drivers, assessed break-even points under different utilization scenarios through sensitivity analyses, and evaluated their implications for procurement decisions and implementation strategies in the ICU setting.

During the study period from 1 January 2023 to 31 December 2024, on average 1,253 bronchoscopic procedures were performed in the ICU setting. Cost per procedure were € 346.19 per use for SFB and € 97.28 for RFB with a break-even point for cost effectiveness of RFB of 317 procedures per year. Sensitivity analysis showed robustness of the results in our setting of high procedure volume to variable maintenance costs and reduction in investment costs of SFB.

For the German ICU setting with in-house reprocessing and high procedure volume, RFB is cost effective compared to SFB.