Disposable sheaths use versus instruments reprocessing for nasopharyngolaryngoscopy in ENT-clinic: a cost-minimization analysis

Disposable sheaths use versus instruments reprocessing for nasopharyngolaryngoscopy in ENT-clinic: a cost-minimization analysis

Authors

  • Mario Cesare Nurchis Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Department of Health Sciences and Public Health, Section of Hygiene, Università Cattolica del Sacro Cuore, Rome, Italy
  • Maria Michela Giannino Department of Public Health and Paediatrics, Università di Torino, Torino, Italy
  • Marcello Di Pumpo Department of Health Sciences and Public Health, Section of Hygiene, Università Cattolica del Sacro Cuore, Rome, Italy
  • Vittorio De Vita Department of Health Sciences and Public Health, Section of Hygiene, Università Cattolica del Sacro Cuore, Rome, Italy
  • Antonio Moffa Integrated Therapies in Otolaryngology, Campus Bio-Medico University, Rome, Italy; Unit of Otolaryngology, University of Foggia, Italy
  • Lucrezia Giorgi Integrated Therapies in Otolaryngology, Campus Bio-Medico University, Rome, Italy
  • Lorenzo Sabatino Integrated Therapies in Otolaryngology, Campus Bio-Medico University, Rome, Italy
  • Lorenzo Sommella Hospital Management, Campus Bio-Medico University, Rome, Italy
  • Manuele Casale Integrated Therapies in Otolaryngology, Campus Bio-Medico University, Rome, Italy
  • Gianfranco Damiani Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Department of Public Health and Paediatrics, Università di Torino, Torino, Italy

Keywords:

Cost-minimization analysis; endoscopes; disposable equipment; Health Care Economics and Organizations

Abstract

Background. Nasopharyngolaryngoscopes reprocessing is often suboptimal and breaches in reprocessing protocols are commonly reported. Single-use sheaths help in reducing endoscope contamination. The aim of the study is to compare costs related to disposable instruments reprocessing and the single-use sheaths alternative. Research design and methods. A cost-minimization analysis to compare fiberoptic nasopharyngolaryngoscopy instruments reprocessing with disposable sheaths use was performed through the micro-costing approach with data from teaching hospital and costs in euros referred to 2022, following the Consolidated Health Economic Evaluation Reporting Standards. Results. In the base-case scenario, using disposable sheaths costs € 2,600 less than using cleaning and sterilization procedures. The analysis of direct medical costs, which included personnel, equipment and operating costs, and consumables, revealed higher costs related to personnel for the cleaning and sterilization alternative. Sensitivity analysis further supported the robustness of the cost-saving findings, with variations in disposable sheaths cost and sterilization kits demonstrating significant impacts on the cost difference between the two alternatives. Conclusions. Based on the study findings, this economic analysis shows that using disposable sheaths covering nasopharyngolaryngoscopes is an appropriate cost-saving strategy. Further studies on a larger scale are needed to confirm these encouraging results

References

1. Walczak R, Arnold M, Grewal J, Yuan X, Suryadevara A, Marzouk H. Reusable vs disposable nasopharyngolaryngoscopes: Cost analysis and resident survey. Laryngoscope Investig Otolaryngol. 2020 Dec 10;6(1):88-93. https:// doi.org/10.1002/lio2.500. PMID: 33614935; PMCID: PMC7883614.

2. Muscarella LF. Prevention of disease transmission during flexible laryngoscopy. Am J Infect Control. 2007 Oct;35(8):536-44. doi: 10.1016/j.ajic.2006.09.010. PMID: 17936146.

3. Vincenti S, Colamesta V, Nurchis MC, Damiani G, Pascucci D, Boninti F, et al. Development of a checklist as selfassessment tool to evaluate the reprocessing of endoscopic instruments in an Italian teaching hospital. Eur Rev Med Pharmacol Sci. 2021 Aug;25(15):5029-41. doi: 10.26355/ eurrev_202108_26460. PMID: 34355375.

4. Alvarado CJ, Anderson AG, Maki DG. Microbiologic assessment of disposable sterile endoscopic sheaths to replace high-level disinfection in reprocessing: A prospective clinical trial with nasopharygoscopes. Am J Infect Control. 2009 Jun;37(5):408-13. doi: 10.1016/j.ajic.2009.04.276. PMID: 19482219.

5. Putnam K. Guideline for processing flexible endoscopes. In: Guidelines for Perioperative Practice. AORN, Inc; 2019. p. 199-288.

6. Hanly M, Churches T, Fitzgerald O, Caterson I, MacIntyre CR, Jorm L. Modelling vaccination capacity at mass vaccination hubs and general practice clinics: a simulation study. BMC Health Serv Res. 2022 Aug 19;22(1):1059. doi: 10.1186/s12913-022-08447-8. PMID: 35986322; PMCID: PMC9388987.

7. Chu DK, Akl EA, Duda S, Solo K, Yaacoub S, Schünemann HJ, et al. Physical distancing, face masks, and eye protection to prevent person-to-person transmission of SARS-CoV-2 and COVID-19: a systematic review and meta-analysis. Lancet. 2020 Jun;395(10242):1973-87. doi: 10.1016/S01406736(20)31142-9. Epub 2020 Jun 1. PMID: 32497510; PMCID: PMC7263814.

8. Jones NR, Qureshi ZU, Temple RJ, Larwood JPJ, Greenhalgh T, Bourouiba L. Two metres or one: what is the evidence for physical distancing in covid-19? BMJ. 2020 Aug 25;m3223. doi: 10.1136/bmj.m3223. PMID: 32843355.

9. Mick P, Murphy R. Aerosol-generating otolaryngology procedures and the need for enhanced PPE during the COVID-19 pandemic: a literature review. J Otolaryngol Head Neck Surg. 2020 May 11;49(1):29. doi: 10.1186/s40463020-00424-7. PMID: 32393346; PMCID: PMC7212733.

10. Ofstead CL, Hopkins KM, Quick MR, Brooks KB, Eiland JE, Wetzler HP. A Systematic Review of Disposable Sheath Use During Flexible Endoscopy. AORN J. 2019 Jun 28;109(6):757-71. doi: 10.1002/aorn.12699. PMID: 31135992.

11. Biadsee A, Crosby L, Chow W, Sowerby LJ. Cost minimization analysis of nasopharyngoscope reprocessing in community practice. J Otolaryngol Head Neck Surg. 2023 Feb 8;52(1):8. doi: 10.1186/s40463-022-00610-9. PMID: 36750881; PMCID: PMC9906939.

12. Cabrera CI, Ning AY, Cai Y, D’Anza B. Systematic Review of Telehealth Cost Minimization for Patients and Health Systems in Otolaryngology. Laryngoscope. 2021

Aug;131(8):1741-8. 1741-1748. doi: 10.1002/lary.29321.

Epub 2020 Dec 23. PMID: 33355932.

13. Tam S, Sun H, Sarma S, Siu J, Fung K, Sowerby L. Medialization thyroplasty versus injection laryngoplasty: a cost minimization analysis. J Otolaryngol Head Neck Surg. 2017 Feb 20;46(1):14. doi: 10.1186/s40463-017-0191-5. PMID: 28219447; PMCID: PMC5319113.

14. Agenzia per la rappresentanza negoziale delle pubbliche amministrazioni. Contratto Collettivo Nazionale di Lavoro dell’area Sanità - Triennio 2016-2018. 2020. GU Serie Generale n. 22 del 28-01-2020 (Suppl Ord n. 6).

15. Sami SS, Dunagan KT, Johnson ML, Schleck CD, Shah ND, Zinsmeister AR, et al. A randomized comparative effectiveness trial of novel endoscopic techniques and approaches for Barrett’s esophagus screening in the community. Am J Gastroenterol. 2015 Jan;110(1):148-58. doi: 10.1038/ ajg.2014.362. Epub 2014 Dec 9. PMID: 25488897; PMCID: PMC4387566.

16. Jin P, Wang X, Yu D, Li A, Wang H, Meng M, et al. Safety and efficacy of a novel disposable sheathed gastroscopic system in clinical practice. J Gastroenterol Hepatol. 2014 Apr 20;29(4):757-61. doi: 10.1111/jgh.12482. PMID: 24325649.

17. Bretthauer M, Hoff G, Thiis-Evensen E, Grotmol T, Larsen IK, Kjellevold Ø, et al. Use of a Disposable Sheath System for Flexible Sigmoidoscopy in Decentralized Colorectal Cancer Screening. Endoscopy. 2002 Oct;34(10):814-8. doi: 10.1055/s-2002-34273. PMID: 12244504.

18. Shariff M, Varghese S, O’Donovan M, Abdullahi Z, Liu X, Fitzgerald R, et al. Pilot randomized crossover study comparing the efficacy of transnasal disposable endosheath with standard endoscopy to detect Barrett’s esophagus. Endoscopy. 2015 Nov 4;48(02):110-6. doi: 10.1055/s-00341393310. Epub 2015 Nov 4. PMID: 26535563; PMCID: PMC6055986.

19. Silberman HD. Non-Inflatable Sterile Sheath for Introduction of the Flexible Nasopharyngolaryngoscope. Ann Otol Rhinol Laryngol. 2001 Apr 29;110(4):385-7. doi: 10.1177/000348940111000417. PMID: 11307918.

20. Deepak G, Arvind S, Hong W. Reduced turnover times make flexible optical reusable scope with EndoSheath&reg Technology significantly cost-effective. J Biomed Res. 2012;26(4):241. doi: 10.7555/JBR.26.20120050. Epub 2012 Jul 8. PMID: 23554755; PMCID: PMC3596739.

21. Tan SS. Microcosting in Economic Evaluations. Issues of accuracy, feasibility, consistency and generalisability [Internet]. Rotterdam, Netherland: Optima Grafische Communicatie; 2009. Available from: https://core.ac.uk/download/ pdf/18510449.pdf

22. Andronis L, Barton P, Bryan S. Sensitivity analysis in economic evaluation: an audit of NICE current practice and a review of its use and value in decision-making. Health Technol Assess. 2009 Jun;13(29): iii, ix-xi, 1-61. doi: 10.3310/ hta13290. PMID: 19500484.

23. Becker S, Thum K, Philipp J, Hagemann J, Eckrich J, Ernst B. Kostenvergleichsanalyse von flexiblen HNO-Endoskopen. Laryngorhinootologie. 2021 May;100(5):382-92. German. doi: 10.1055/a-1200-1859. Epub 2020 Jul 22. PMID: 32698200.

24. Ellis J, Park AH, Prussin A. A cost comparison between reusable flexible and disposable laryngoscopes. Am J Otolaryngol. 2022 Mar-Apr;43(2):103321. doi: 10.1016/j.amjoto.2021.103321. Epub 2021 Dec 15. PMID: 34953249.

25. Jegatheeswaran L, Oungpasuk K, Choi B, Nakhoul M, Gokani S, Espehana A, et al. Disposable versus reusable fibre-optic nasendoscopes: a national survey of UK ENT surgical trainees and a single-centre cost-analysis. J Laryngol Otol. 2023 Aug 11;137(8):866-72. doi: 10.1017/S0022215122002274. Epub 2022 Oct 11. PMID: 36217672.

26. Mosconi C, De Santo C, Ciccacci F, Carestia M, Guarente L, Di Giovanni D, et al. Costs and control strategies of healthcare-associated infections in an Italian university hospital. Eur J Public Health. 2023 Oct;33(Suppl 2):ckad160.747. https://doi.org/10.1093/eurpub/ckad160.747. PMCID: PMC 10497296.

27. Namburar S, von Renteln D, Damianos J, Bradish L, Barrett J, Aguilera-Fish A, et al. Estimating the environmental impact of disposable endoscopic equipment and endoscopes. Gut. 2022 Jul;71(7):1326-31. doi: 10.1136/gutjnl-2021324729. Epub 2021 Dec 1. PMID: 34853058.

28. Drummond MF, Sculpher MJ, Claxton K, Stoddart GL, Torrance GW. Methods for the Economic Evaluation of Health Care Programmes. 4th ed. Oxford: Oxford University Press; 2015.

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Published

2025-04-16

Issue

Vol. 37 No. 5 (2025)

Section

Original research

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Copyright (c) 2025 Mario Cesare Nurchis, Maria Michela Giannino, Marcello Di Pumpo, Vittorio De Vita, Antonio Moffa, Lucrezia Giorgi, Lorenzo Sabatino, Lorenzo Sommella, Manuele Casale, Gianfranco Damiani (Author)

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How to Cite

1.
Nurchis MC, Giannino MM, Di Pumpo M, et al. Disposable sheaths use versus instruments reprocessing for nasopharyngolaryngoscopy in ENT-clinic: a cost-minimization analysis. Ann Ig. 2025;37(5):610-617. doi:10.7416/ai.2025.2692