Cost Effectiveness Analysis of Flexible Optical Scopes for Tracheal Intubation

Introduction

The flexible optic scope is a primary method of performing intubations as a way of managing the difficult airway algorithms. The process is common among anesthesiologists. The method is only among other methods that could be initiated to serve the same purpose. The major differences among the various methods, which could be used, are costs effectiveness and reliability. This paper entails an analysis of the flexible optical scopes and the associated effectiveness in tracheal incubation. Flexible Optic Scopes in this case referred to both fiber-optic scopes and video scopes. The flexible fiber-optic form of intubation refers to an integral part of the Difficult Airways Algorithm but it has limited use mainly the non-emergent scenarios of difficult airways. The reason behind this limited use is its high costs of purchasing and maintenance. This type of incubation also requires the initiation of advanced training. While there exists two distinct forms of flexible scopes in terms of usability, the flexible health care facilities have been using for a long time (Tvede et al, 2012). For this research, the single use FOS is found to be the most cost-efficient.

An alternative to the flexible fiber-optic could be the Ambua Scope, which can be accessed easily within various scenarios in emergent clinics. It is also more cost effective compared to other techniques, which have failed due to other reasons besides high costs. Intubation with the use of the flexible optical scope is a great technique in the management of any predicted as well as unpredicted difficulty airway. While the total costs of making use of flexible scopes are entirely unknown, establishing a way to analyze the effectiveness of the technique would be a great idea. This is important especially considering that fiber optic scopes entail both video scopes and the fiber optic scopes. The introduction of flexible scopes, which are disposable, has initiated great change in healthcare and especially in the management of difficult airway according to Smith (2012). The cost effectiveness could however be inadequate for each of the two types of flexible optical scopes.

Background

Decision-making is hardly an easy process since requires significant attention, thoughts and wisdom according to Muennig (2007). This happens in all forms of organization although the health sector and its organizational setting require a bit more creativity in making decisions. Making decisions in the health sector is usually based on factual information rather than on assumptions. Other than the cost effectiveness of the flexible optical scopes, consideration of the health implications is a major consideration. The disposable flexible optical scope is fast gaining popularity among health practitioners (Tvede et al, 2012). The cost associated to the reusable flexible optical scope in performing intubation is however unknown. The real cost is influenced by various factors including its initial cost, its maintenance cost, the cleaning cost, and disinfector costs among other cost factors. In contrasts, the single use flexible optical scope does not need any repair activities or disinfection. It is purchased and used by physicians to perform intubation, with the exclusion of maintenance costs lowering its general costs.

An analysis of the various cost factors associated with the reusable fiber optical scope, would make it easier to recommend the single use fiber optical scope for use in hospital procedures. The definite choice is initiated by fact that the single use fiber optic scope does not need much servicing or cleaning even after use due to its disposable feature (Tvede et al, 2012). It is however vital to conduct a critical analysis of both fiber optic scopes to determine the most effective and efficient especially given that the actual cost implication of the reusable type has never been extracted in any existing or previous research. The background of this cost comparison idea is that the advancement of technological knowledge within the health sector is meant for the benefit of the patient (DeCusatis & DeCusatis, 2006). The technology can hardly be achieved without an aspect of cost considerations. This calls for the essence of scrutinizing all health care approaches to ensure that patients get quality care at an affordable cost (Smith, 2012). This is the central rationale behind carrying out a cost effective analysis for both the re-usable and the disposable flexible optical scans.

Deciding on the best fiber optic scope to use between the single use and the reusable type requires that health practitioners have to put much into consideration. Some considerations made include the aspect of the reusable FOS of having to be cleaned after every intubation. The cost implication associated with this case may not be direct but indirect, adding to the main cost of purchases. Indirect costs have been reported in the form of cases of diseases resulting from the process of decontamination. This aspect could be seen in the case of case of Creutzfeld Jakob disease, which was been diagnosed (Tvede et al, 2012). Technicians find the single use FOS as a significant step in addressing this challenge. This is provided in this case to signify the severity of the issue and the essence of carrying out a cost effective analysis on the two FOS to recommend on the way forward in selecting the most cost effective one.

Such reasoning could be shallow, a factor that would highly call for the use of cost analysis techniques to establish the best method of which to make use. Going by non-factual reasoning would lead people to engage in some critical thinking. This is because, although the use of the single use optical scope may appear cheaper at first but the indirect costs and the prolonged usage could prove it as being the most expensive type of flexible optical scope. Adaptation of new technologies may have own implications especially in the aspect of cost, which brings in ungrounded reasons for re-adapting earlier technologies due to their simplicity. New technologies usually consider cost implications, which could imply that the disposable optical scope has some cost advantages over the single use type. This argument is the ground for the cost effective analysis carried out in this paper.

The main challenge today is the adaptation to new technologies quickly without making any considerations such as the effects of adapting to them (Smith, 2012). It is true that most technological changes aim at improving on the present conditions, however, this does not mean that there is no need for exercising thoughts and considerations (Smith, 2012). In any case, there should be a thorough analysis of each form of intubation before a choice decision is made. This means that it is unnecessarily adequate to recommend one single FOS to manage all cases of predicted and unpredicted difficult airway. This is because each of the method may prove to be cost effective in different circumstances (Smith, 2012). For instance, physicians should consider the number of booked intubations before making the final decision oHin which FOS to use. This could ensure that the right equipment is used at the right time with the observation of cost effectiveness.

Literature review

Studies have been conducted on various scopes to investigate the cost advantages and effectiveness of each of the two types of flexible optical scopes. Numerous studies have been conducted in various parts of the world to carry out cost effective analyses on the two FOS. In one of the studies, this paper examines the detail aspects in the attempt to analyzing the cost effectiveness of both the disposable and the reusable flexible optical scopes. In countries like Denmark, similar analysis was carried out, in this case, in Copenhagen university hospital (Tvede et al, 2012). The study established that in the hospital, where the study was conducted, use Classical FOS containing optical fibers with an eyepiece at the proximal end were in use until during recent years. The study further revealed that sometimes a separate video camera would be attached to the eyepiece. However, during recent years several video, fiber, or hybrid scopes have become available (Tvede et al, 2012). This has led to the hospital offering disposable flexible video scopes to its anesthetists. According to the study, the recent introduction of the disposable FOS has called for a cost analysis (Tvede et al, 2012). The initiation of a cost-analysis process was to find the cost advantage of the disposable flexible optical scope in order to allow a cheap or affordable adaptability. From the study results, some people are strongly requesting a healthy economic study, which deals with the subject. This confirms that the single use flexible optical scopes are rapidly gaining influence in health settings.

From the study, it comes out that the total cost associated with flexible optical scope intubation has hardly been published any time before. Again, the costs of repairing equipments used in bronchoscopes have once been calculated, but the study focused on repair costs only in a pulmonology setting (Tvede et al, 2012). They measured and calculated actual total costs per intubation. This was done using a combination of traditional fiber and video scopes. The cost incurred was compared to the cost of using a single use flexible video scope. To understand the study, it is necessary to comprehend the method used. This is vital as the study is used in the paper to determine the cost effectiveness of the two FOS.

The cost of intubation using reusable FOSs was identified and calculated. One of the people underrating the study was a health economist. The duty of the economist was to ensure that the methodology of the study addressed the purpose (Tvede et al, 2012). The study was taking place at a multidisciplinary university affiliated anesthesia department. It provides about 80000 operations per year. This is especially within burns and plastics, oral and maxillofacial, eye, trauma, ear-nose, orthopedic and throat surgery. The number of actual intubations was extracted from the relevant database. The study also provides that the department have about 12 FOS at its disposal (Tvede et al, 2012). This means that the number of FOS is high enough to address multiple cases at once. According to the study, anesthesia activities in the department are spread in about four different areas. These places are situated at different floors. It is further revealed that the disinfectant-washer is placed on one floor (Tvede et al, 2012). This is to say that all the entire FOSs have to be brought to one floor for cleaning and disinfecting after every intubation.

In order to calculate total costs incurred, when using FOS, the procedure was observed from the start to the end. The process of data collection that involved observing the procedures took place for a period of two months (Tvede et al, 2012). At the beginning of the period, the observations were made by authors and team members. Information regarding the purchase of the available FOS and equipments that are directly related to the functioning of the FOS was gotten from the technical department of the hospital. Another relevant piece of information is the expected life of scopes and racks. Information regarding the cost of repairs was obtained from the hospital’s maintenance recordings of the hospital’s medical technical department (Tvede et al, 2012). During the collection of this information, it was revealed that a hospital medical technician used half of her working time servicing endoscopic equipment belonging to the hospital. The 12 FOS given to this department (multidisciplinary anesthesia) constitute of about 5% of the hospitals equipment (Tvede et al, 2012).

The cost of buying and operating the department’s washer-disinfector for the FOS was obtained from the manufacturer (Tvede et al, 2012). The cost of the space needed to be used in washing and disinfecting the endoscopes is estimated from the cost of an average square meter in a hospital setting in the city of Copenhagen. The cost of additional necessary, which is used for the procedure, was given to the researchers by the procurement department (Tvede et al, 2012). The various costs are listed to help the reader gain a clear understanding of the factors that are considered when establishing a cost effective analysis.

The calculated cost per every intubation encompasses all elements or aspects linked to the procedure except the time used by the physicians (anesthesiologists) to perform m the actual intubation. This is because this factor varies a lot. For instance, each doctor may have a different skill level. Doctors with high skills tend to perform the intubation faster than doctors with low skills. Teaching situations could also influence the length of an intubation (Tvede et al, 2012). These levels are disregarded when determining the cost analysis, as they cannot be adjusted to be used in the analysis.

In the study cost per intubation, reusable was said to be the total cost of all miscellaneous elements divided by the sum of intubations performed annually. After all the calculations were done, it was discovered that the cost of using reusable flexible optical scope was £ 177.7 per intubation (Tvede et al, 2012). The cost of using the disposable video scope was £204.4 (Tvede et al, 2012). These figures reveal that using reusable FOS is more cost effective than using disposable FOS. However, when other factors were considered, the results changed. For instance, a subgroup analysis indicated that the cost of intubation of a person using a reusable scope with a video monitor was £204.5 (Tvede et al, 2012). This reveals that looking at a specific set of factors may not yield the proper results. It is essential to integrate as many factors as possible when determining cost effectiveness (Smith, 2012). This helps one to get informed views from different point of views. This is helpful as one is able to choose the cost-effective approach based on the prevailing circumstances.

Decisional Model

The main aim of this decision model is to aid in making informed choices on the flexible optical scopes. This would a better way of settling into a conclusion about the most cost efficient flexible optical scope in contrast to the attitudes of many people to make choices out of tradition or habit according to Muennig (2007). In many cases, such people hardly undertake a systematic approach to decision making (Muennig, 2007). In this case, it is essential to adopt a systematic approach to decision making. This is because, if one is not careful, decision-making can be influenced by a variety of factors such as emotions that affect decision making negatively (Smith, 2012). Still, lack of information and proper skills leads to bad decisions. Because of the reasons provided and many others, this article adopts a professional model to help in making the right decision while choosing the most cost effective FOSs.

Figure1: A Decision Analysis Model

From the decision analysis model, it can be evident that the single use FOS is more cost efficient than the reusable FOS. The cost of the single use FOS is relatively lower than the cost of the reusable FOS. To get into the final solution in the decision making process, various steps are conducted before reaching a feasible conclusion. The various stages are designed to help decision makers approach issues comprehensively and systematically. The decision makers have to start from a point and there is also an ending point after the entire process of decision-making. In the identification of the problem or situation, the decision makers need to have a clear objective such as the cost effectiveness they would like to achieve from the use of a specific method. The major decision in this case is making the right choice out of the flexible optical method that would lead to cost effectiveness. From the two choices available, the decision makers would be able to identify possible alternatives. Identification of alternatives would require that the better of the two methods be chosen. The identification of alternatives is done using specific strategies. The alternatives have to have to indicate the possibility of reaching good decisions. From the available strategies, they would then decompose and model the problem, which is cost effectiveness in this case. The best alternative is then chosen. The choice of the best alternative is done carefully and with respect to the established objectives. In this case, the single use FOS could be chosen over the reusable alternative because it is much cheaper, the repair and maintenance costs are lower, there are low or no chances of disinfection cost, and the repair to procedure cost is lower than that of the reusable FOS. In this case, the repair to procedure ratio is 1:39 for the single use FOS compared to

Estimating probabilities

To estimate probabilities, there is the need to have some information on both the usage of reusable and disposable FOS. In the case of the reusable FAO, one has to collect data regarding the buying price, the maintenance cost, for a given period of time. Other costs to consider in this case include the cost of the washing-disinfectant and other costs related to the use of the device. On the other hand, the cost associated with the disposable FOS is the purchasing cost and the labor cost (Tvede et al, 2012). Other costs are either negligible or do not exist for this kind of FOS. After establishing this information, calculations would be carried out and adjusted to reflect different periods of time (Tvede et al, 2012). The information obtained after the calculations is useful in comparing and establishing the best approach to use in different occasions. The data collected is presented in the table below:

Table 1: Cost Differences between the Reusable and the Single-Use FOS

Costs Reusable Single Use

Purchase cost 557 300

Repair cost 53.46 53.48

Disinfection and preparation cost 33.16 0

Intubation Cost 119.75 120

Total Cost for Each type 763.37 473.48

The probability that the management would choose to use the single use FOS or the reusable FOS depends on the respective costs. The management chooses the option characterized by higher cost effectiveness. In this case, the probability of choosing one kind of the FOS could be established from the relative total costs for each FOS type. From the sensitivity analysis section, the total cost estimate for the reusable FOS is $763.37 while that of the single use FOS is $473.48. The total cost of using the two types of FOS is $1236.85. This implies that the fraction representing the total cost of the reusable FOS would be 763.37/1236.85, which comes to 0.6171888264542992. On the other hand, the cost fraction for the single use FOS is 473.48/1236.85, which becomes 0.3828111735457008. In this case the cost effectiveness would be higher for the smaller fraction while. Therefore, the probability that the management would make use of the single use FOS over the reusable FOS is 763.37/1236.85, which is equal to 0.617. The probability that the management would continue with the use of the reusable FOS is 473.48/1236.85, which is presented as 0.38.

Cost estimates

The cost estimates for the two FOS types depict significant differences, which signify great reasons why the two types of FOS have different effectiveness. The cost purchasing a single reusable FOS is about $557. This implies that for 6 units, the cost of purchase is $3342. The cost of purchasing the single use FOS is $300, an implication that the latter is cheaper. With respect to other cost implications, the reusable FOS is more costly than the single use FOS. The repair cost for one unit is estimated to be $53.46 while the repair cost for the single use is almost equal amounting to $53.48. While the disinfection and preparation cost for the reusable FOS is estimated to be $33.16, the single user has not disinfection or preparation cost. It has however, a slightly higher or almost equal intubation cost, $120, over 119.75 for the reusable FOS. The total cost is much higher for the reusable FOS since it stands at $763.37 against $473.48 for the single use FOS.

Sensitivity analysis

The sensitivity analysis involves the consideration the factors that may influence the alternative selected. It involves the establishment of the way the uncertainty in the selection between the reusable FOS and the single use FOS would be apportioned. This would differentiate the source uncertainties in the use of the two forms of FOS. The costs can be compared in a table as shown in the table presentation below:

Costs Reusable ($) Single Use($)

Purchase cost 557 300

Repair cost 53.46 53.48

Disinfection and preparation cost 33.16 0

Intubation Cost 119.75 120

Total Cost for Each type 763.37 473.48

From the table, the cost for a single unit for each unit is $763.37 for the reusable FOS and $473.48 for the single use FOS. The difference is $289.89, which would increase as the number of units increase. This means that if the organization uses 10 units of the reusable FOS instead of the single use FOS, it would incur and extra cost of $2898.9.

Summary

As discussed in the paper, cost effectiveness of any of the FOS ‘depend on a variety of factors that are directly related to cost. On the other hand when conducting few flexible optical nerves, a disposable flexible optical scope is cost effective. The best choice depends on the prevailing factors. It is advisable for health practitioners to use the decision analysis model provided in the article to come up with the best option in terms of cost effectiveness. In addition to this consideration, it is also necessary to bear in mind that other factors must also be considered. For this case, it can be concluded that the single use is the best since it has a higher level of cost effectiveness.

References

DeCusatis, C., & DeCusatis, C. J. S. (2006). Fiber optic essentials. Amsterdam: Elsevier/Academic Press.

Muennig, P. (2007). Cost-Effectiveness Analysis in Health: A Practical Approach. Hoboken: John Wiley & Sons.

Smith, A. D. (2012). Smith’s textbook of endourology. Chichester, U.K: Wiley.

HYPERLINK “http://www.ncbi.nlm.nih.gov/pubmed?term=Tvede%20MF%5BAuthor%5D&cauthor=true&cauthor_uid=22338623” Tvede MF, HYPERLINK “http://www.ncbi.nlm.nih.gov/pubmed?term=Kristensen%20MS%5BAuthor%5D&cauthor=true&cauthor_uid=22338623” Kristensen MS, HYPERLINK “http://www.ncbi.nlm.nih.gov/pubmed?term=Nyhus-Andreasen%20M%5BAuthor%5D&cauthor=true&cauthor_uid=22338623” Nyhus-Andreasen M. (2012). A cost analysis of reusable and disposable flexible optical scopes for intubation.. Pub med.gov. Retrieved from HYPERLINK “http://www.ncbi.nlm.nih.gov/pubmed/22338623” http://www.ncbi.nlm.nih.gov/pubmed/22338623