Reply: Cost-Effectiveness of Disposable Bronchoscopes

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Kuwal and colleagues suggest that fiberoptic bronchoscopy is an alternative to both conventional video bronchoscopy and single-use bronchoscopy. Our objective was to describe the use of single-use bronchoscopes in the intensive care unit (ICU) of a tertiary referral center and to compare this with conventional reusable bronchoscopy. Fiberoptic bronchoscopy without the video component is not commonly used in our center and therefore a comparison of current practice versus newer single-use bronchoscopy was considered more appropriate. In centers where fiberoptic bronchoscopes are in more regular use this comparison may be relevant. As with single-use bronchoscopes, using a fiberoptic bronchoscope eliminates the requirement to transfer the video stack and equipment.
A disadvantage of fiberoptic bronchoscopy is that only the operator can visualize the bronchial tree. The disposable bronchoscope with video monitor first allows teaching for the intensive care trainees and further allows other members of the clinical team to view the bronchial tree and contribute to diagnosis and management. As highlighted single-use bronchoscopes also offer 0 risk of cross-contamination.
In our ICU between 100 and 150 bronchoscopies were performed annually. Kuwal et al quote findings that in a center where <200 bronchoscopies are performed annually then reusable bronchoscopes are more cost-effective.1 These findings are consistent with those in our analysis that single-use bronchoscopes were as cost-effective as conventional bronchoscopes. As stated in our limitations our findings for cost-effectiveness and utility are not necessarily generalizable and are likely relevant to centers with similar ICU settings and procurement costs.
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