A Cost-Effectiveness Analysis Comparing the VivaSight Double-Lumen Tube and a Conventional Double-Lumen Tube in Adult Patients Undergoing Thoracic Surgery Involving One-Lung Ventilation

Abstract

Background: One-lung ventilation (OLV) procedures are essential for most thoracic surgeries, and the most common method is intubation with a conventional double-lumen tube (cDLT) and bronchoscopy to verify correct tube placement.

Objective: The objective of this study was to conduct a cost-effectiveness analysis comparing the VivaSight double-lumen tube (DL) and a cDLT for OLV procedures.

Methods: A cost-effectiveness analysis was conducted from a healthcare sector perspective in Denmark using a decision analytic model to assess the potential effects and costs of using VivaSight-DL as an alternative to a cDLT with a reusable bronchoscope. Costs were determined using a micro-costing approach. The effectiveness measure was the number of times that fiberoptic confirmation of the tube placement during intubation or surgery was unnecessary and thus avoided. The effectiveness input was from a randomized controlled trial (n = 52). Both deterministic and probabilistic sensitivity analyses were conducted to assess the robustness of the results.

Results: Fiberoptic confirmation of tube placement was only necessary in two (6.66%) procedures using VivaSight-DL. The cost of using VivaSight-DL was $US299.96 per procedure versus $US347.61 for a cDLT with a reusable bronchoscope. The incremental cost-effectiveness ratio was - $US51.06 per bronchoscopy avoided. The base-case analysis indicated that the use of VivaSight-DL was cost effective compared with the use of a cDLT with reusable bronchoscope. Sensitivity analyses showed that the results were robust and that VivaSight-DL was more effective and less costly.

Conclusion: This study suggests that VivaSight-DL is associated with cost savings and reductions in bronchoscope use to verify correct tube placement. The conclusion is based on the results from a single institution. To clarify whether VivaSight-DL is cost effective in larger or global clinical settings, further economic evaluations should be performed.

Fig. 1

Decision analytic model for cost effectiveness of VivaSight-double-lumen (DL) tube vs. conventional double-lumen tube (cDLT)

Fig. 2

Equivalence point for when VivaSight-DL used with a single-use bronchoscope (aScope™4 Broncho) no longer is associated with cost savings. Annual number of procedures: 600. cDLT conventional double-lumen tube, DL double-lumen tube

Fig. 3

Two-way sensitivity analyses. The blue area indicates savings from using VivaSight-DL and the red area indicates savings from using reusable bronchoscopes. DL double-lumen tube

Fig. 4

Scatterplot from the probabilistic sensitivity analysis. 100% of the iterations are located in the south-eastern quadrant. The ellipse indicates the 95% confidence interval