OBJECTIVES : Investing in disruptive medical devices are often associated with significant economic uncertainties. Budget impact analyses (BIA) are suitable to inform decision-makers when published health economic evidence is limited and/or unrepresentative for the specific setting introducing the new technology. This is the first example of a budget impact analysis comparing conventional reusable bronchoscopes to single-use bronchoscopes.

METHODS : A BIA was conducted to estimate the incremental cost of a current setup with reusable bronchoscopes vs Ambu aScope4 Broncho. Efficacy of the two technologies were assumed equal, based on published literature. The most central data in the model was sampled from Kings Collage Hospital. This included procedures p.a., number of reusable bronchoscopes (RB), cost of RB, repair costs p.a., number of rack systems, cost of replacement lamps and light guide cables, and number of aView monitors in a new aScope4 Broncho setup. Missing datapoints were based on assumptions from other UK hospitals. A 3.5% discount rate and 5-8 years annuitizing periods were used. Capital costs were not projected, and overhead costs were not added. Robustness of the base-case results were tested via two-way sensitivity analysis. Furthermore, isopleths were identified based on varying procedures p.a. and infection rates.

RESULTS : At 500 procedures p.a. the aScope4 Broncho is cost-minimising of £115 per procedure on direct cost of use and £358 when including cost associated with a 1.6% risk of cross-infection. Cost-isopleths were identified at 903 procedures and 3,175 procedures at 0 and 0.6% infection-risk, respectively.

CONCLUSIONS : The BIA finds that aScope4 Broncho is cost minimizing in the modelled scenario. The base-case result is sensitive to the volume of procedures p.a., infection rate, and capital costs. Furthermore, ascribing a repair cost correlated to the procedure volume increased the RB dominance at a low procedure volume, and increased aScope4 Broncho dominance at a high procedure volume.