OBJECTIVES : Flexible bronchoscopy is a common therapeutic and diagnostic procedure conducted in different hospital settings. Annually, 500,000 flexible bronchoscopy procedures are performed in the US. Numerous analyses have been published investigating the costs associated with flexible bronchoscopy. We aimed to elucidate the cost of use associated with flexible bronchoscopy based on published literature.

METHODS : A targeted literature search was conducted on reusable flexible bronchoscopes. Extracted costs were projected to 2019 using consumer price index (CPI) listed on OECD.org and converted to USD using an average conversion rate. The costs were segmented in countries to show the average costs, range, and standard deviations (SD) per reusable bronchoscopy procedure. Cost per bronchoscopy included capital investments, repair/maintenance, and reprocessing costs.

RESULTS : The average cost of use was $368 (range: $89-$927; SD: $214) including capital investments of $123 (range: $16-$351; SD: $101), repair costs of $107 (range: $21-$386; SD: $107), and reprocessing costs of $139 (range: $6-$479; SD: 149) distributed between six countries and 18 studies. The average cost of use per country was $212, $412 (range: $89-$927; SD: $270), $277, $509, $385 (range: $312-$445; SD: $68), and $237 (range: $111-458; SD: $192) for Denmark, France, Germany, Singapore, UK, and USA, respectively. In addition, the average annual procedure volume per reusable flexible bronchoscope was 30, 73, 8, 27, and 61 in Denmark, France, Germany, UK, and USA, respectively.

CONCLUSIONS : We found that the total average cost of use varied remarkably amongst included studies, and that the cost was somewhat evenly distributed between capital investments, repair/maintenance, and reprocessing cost. However, in various studies the costing method was unclear. This indicates the need of utilizing the micro-costing methodology when conducting cost analysis on medical devices to increase accuracy and decrease inter- and intra study bias and heterogeneity.