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Background: As the United States moves toward value-based care metrics, it will become essential for anesthesia groups nationwide to understand the costs of their services. Time-driven activity-based costing (TDABC) estimates the amount of time it takes to perform a clinical activity by dividing complex tasks into process steps and mapping each step and has historically been used to estimate the costs of various health care services. TDABC is a tool that can be adapted for variable staffing models and the volume of service provided. Anesthesia departments often provide staffing for airway response teams (ART). The economic implications of staffing ART have not been well described. We present a TDABC model for ART activation in a tertiary-care center to estimate the cost incurred by an anesthesiology department to staff an ART., Methods: Pages received by the Brigham and Women's Hospital ART over a 24-month time period (January 2019 to December 2020) were analyzed and categorized. The local administrative database was queried for the Current Procedural Terminology (CPT) code used to bill for emergency airway placements. Sessions were held by multiple members of the ART to create process maps for the different types of ART activations. We estimated the staffing costs using the estimated time it took for each type of ART activation as well as the data collected for local ART activations., Results: From the paging records, we analyzed 3368 activations of the ART. During the study period, 1044 airways were billed for with emergency airway CPT code. The average revenue collected per airway was $198.45 (95% CI, $190-$207). For STAT/Emergency airway team activations, process maps and non-STAT airway team activations were created, and third subprocess map was created for performing endotracheal intubation. Using the TDABC, the total staffing costs are estimated to be $218,601 for the 2-year study period. The ART generated $207,181 in revenue during the study period., Conclusions: Our analysis of ART-activation pages suggests that while the revenue generated may cover the cost of staffing the team during ART activations, it does not cover consumable equipment costs. Additionally, the current fee-for-service model relies on the team being able to perform other clinical duties in addition to covering the airway pager and would be impossible to capture using traditional top-down costing methods. By using TDABC, anesthesia groups can demonstrate how certain services, such as ART, are not fully covered by current reimbursement models and how to negotiate for subsidy agreements.As the transition from traditional fee-for-service payments to value-based care models continues in the United States, improving the understanding and communication of medical care costs will be essential. In the United States, it is common for anesthesia groups to receive direct revenue from hospitals to preserve financial viability, and therefore, knowledge of true cost is essential regardless of payer model.1 With traditional payment models, what is billable and nonbillable may not reflect either the need for or the cost of providing the service. As anesthesia departments navigate the transition of care from volume to value, actual costs will be essential to understand for negotiations with hospitals for support when services are nonbillable, when revenue from payers does not cover anesthesia costs, and when calculating the appropriate share for anesthesia departments when bundled payments are distributed., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2022 International Anesthesia Research Society.)

Study Objective: We describe how the coronavirus disease 2019 (COVID-19) pandemic affected the economics of emergency department care (ED)., Methods: We conducted an observational study of 136 EDs from January 2019 to September 2020, using 2020-to-2019 3-week moving ratios for ED visits, complexity, revenue, and staffing expenses. We tabulated 2020-to-2019 staffing ratios and calculated hour and full-time-equivalent changes., Results: Following the COVID-19 pandemic's onset, geriatric (age ≥65), adult (age 18 to 64), and pediatric (age <18) ED visits declined by 43%, 40%, and 73%, respectively, compared to 2019 visits and rose thereafter but remained below 2019 levels through September. Relative value units per visit rose by 8%, 9%, and 18%, respectively, compared to 2019, while ED admission rates rose by 32%. Both fell subsequently but remained above 2019 levels through September. Revenues dropped sharply early in the pandemic and rose gradually but remained below 2019 levels. In medium and large EDs, staffing and expenses were lowered with a lag, largely compensating for lower revenue at these sites, and barely at freestanding EDs. Staffing and expense reductions could not match revenue losses in smaller EDs. During the pandemic, emergency physician and advanced practice provider clinical hours and compensation fell 15% and 27%, respectively, corresponding to 174 lost physician and 193 lost advanced practice provider full-time-equivalent positions., Conclusion: The COVID-19 pandemic adversely impacted the economics of ED care, with large drops in overall and, in particular, low-acuity ED visits, necessitating reductions in clinical hours. Staffing cutbacks could not match reduced revenue at small EDs with minimum emergency physician coverage requirements., (Copyright © 2021 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.)

Introduction: The advent of wide-awake local anaesthesia has led to a reduced need for main theatre for trauma and elective plastic procedures. This results in significant cost-benefits for the institution. This study aims to show how a dedicated 7 days/ week plastic surgery procedural (PSP) unit, performing both elective and trauma surgeries, can lead to significant cost-benefits for the institution., Methods: Retrospective review of all cases performed in the PSP unit between 1 September and 31 August 2018. We utilised hospital directory admissions data and the hospital's intranet operating theatre system to calculate hospital days saved. Cost analysis was performed using Saolta financial data., Results: A total of 3058 operations were performed. Of these operations, 2388 cases were elective and 670 were trauma cases. The average waiting time for trauma cases for main operating theatre was 1.4 days, saving a total of 487 hospital days. The total savings associated with hospital bed days were €347,861. The estimated resource savings from performing a procedure in PSP compared with main theatre with regional anaesthesia were €529.00 and €391.00 without regional anaesthesia. The cost saved due to resources was therefore €337,226. The total cost-benefit associated with performing surgeries in PSP including hospital days and resources saved was calculated as €685,087., Conclusion: This study shows the benefit of performing elective and trauma operations in minor procedure units such as PSP. PSP results in a more efficient service, reducing waiting times for surgery, shorter hospital stay, reduced operating cost and an overall significant cost saving., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Background: Surgical safety has advanced rapidly with evidence of improved patient outcomes through structural and process interventions. However, knowledge of how to apply these interventions successfully and sustainably at scale is often lacking. The 2019 Global Ministerial Patient Safety Summit called for a focus on implementation strategies to maintain momentum in patient safety improvements, especially in low- and middle-income settings. This study uses an implementation framework, knowledge to action, to examine a model of nationwide World Health Organization (WHO) Surgical Safety Checklist implementation in Cameroon. Cameroon is a lower-middle-income country, and based on data from high- and low-income countries, we hypothesized that more than 50% of participants would be using the checklist (penetration) in the correct manner (fidelity) 4 months postintervention., Methods: A collaboration of 3 stakeholders (Ministry of Health, academic institution, and nongovernmental organization) used a prospective observational design. Based on knowledge to action, there were 3 phases to the study implementation: problem identification (lack of routine checklist use in Cameroonian hospitals), multifaceted implementation strategy (3-day multidisciplinary training course, coaching, facilitated leadership engagement, and support networks), and outcome evaluation 4 months postintervention. Validated implementation outcomes were assessed. Primary outcomes were checklist use (penetration) and fidelity; secondary outcomes were perioperative teams' reactions, learning and behavior change; and tertiary outcomes were perioperative teams' acceptability of the checklist., Results: Three hundred and fifty-one operating room staff members from 25 hospitals received training. Median time to evaluation was 4.5 months (interquartile range [IQR]: 4.5-5.5, range 3-7); checklist use (penetration) increased from 20% (95% confidence interval [CI], 16-25) to 56% (95% CI, 49-63); fidelity for adherence to 6 basic safety processes was high: verification of patient identification was 91% (95% CI, 87-95); risk assessment for difficult intubation was 79% (95% CI, 73-85): risk assessment for blood loss was 88% (95% CI, 83-93) use of pulse oximetry was 93% (95% CI, 90-97); antibiotic administration was 95% (95% CI, 91-98); surgical counting was 89% (95% CI, 84-93); and fidelity for nontechnical skills measured by the WHO Behaviorally Anchored Rating Scale was 4.5 of 7 (95% CI, 3.5-5.4). Median scores for all secondary outcomes were 10/10, and 7 acceptability measures were consistently more than 70%., Conclusions: This study shows that a multifaceted implementation strategy is associated with successful checklist implementation in a lower-middle-income country such as Cameroon, and suggests that a theoretical framework can be used to practically drive nationwide scale-up of checklist use.

Health services for pregnancy and delivery at public health facilities are fully subsidized by the government in Mongolia. However, it has been reported that health financing, budget planning, and implementation processes are weak. Therefore, this study aims to estimate the costs per inpatient of vaginal delivery and cesarean section (C-section) by using data gathered from a tertiary hospital in Ulaanbaatar. Inpatient and financial data were collected from the Statistics and Finance, Economics Department of National Center for Maternal and Child Health. A top-down method was used for the calculation of unit costs. The total number of deliveries in 2016 were 11,033, including 7,777 vaginal deliveries and 3,256 C-sections. The cost per inpatient stay for vaginal delivery and C-section were USD 255 and USD 592, respectively. The average cost per bed-day of the six departments of the obstetrics and gynecology hospital was USD 80. The percentage that represents employees' salary in the cost per inpatient was as low as 12.4% for vaginal delivery and 18.5% for C-section, although the cost for salaries accounted for 51.2% of the total expenditure of the hospital. Results show that the cost per inpatient of C-section was two times higher than that of vaginal delivery. The cost of childbirths may account for approximately 9% of total health expenditure of the country. These results may be advantageous to the government in instituting a policy and controlling the health care budget to improve cost-effectiveness and equal access to all in health care services in Mongolia., Competing Interests: The authors declared no conflicts of interest for this study.

Background: Neonatal mortality has been decreasing slowly in Ghana despite investments in maternal-newborn services. Although community-based interventions are effective in reducing newborn deaths, hospital-based services provide better health outcomes., Objective: To examine the process and cost of hospital-based services for perinatal asphyxia and low birth weight/preterm at a district and a regional level referral hospital in Ghana., Methods: A cross-sectional study was conducted at 2 hospitals in Greater Accra Region during May-July 2016. Term infants with perinatal asphyxia and low birth weight/preterm infants referred for special care within 24hours after birth were eligible. Time-driven activity-based costing (TDABC) approach was used to examine the process and cost of all activities in the full cycle of care from admission until discharge or death. Costs were analysed from health provider's perspective., Results: Sixty-two newborns (perinatal asphyxia 27, low-birth-weight/preterm 35) were enrolled. Cost of care was proportionately related to length-of-stay. Personnel costs constituted over 95% of direct costs, and all resources including personnel, equipment and supplies were overstretched., Conclusion: TDABC analysis revealed gaps in the organization, process and financing of neonatal services that undermined the quality of care for hospitalized newborns. The study provides baseline cost data for future cost-effectiveness studies on neonatal services in Ghana., Funding: Authors received no external funding for the study., Competing Interests: Conflict of interest: None declared, (Copyright © The Author(s).)

Background Medication is frequently thrown away after a patient's discharge from hospital, with undesirable economic and environmental consequences. Because of the rising costs of healthcare, interventions to reduce medication wastage (and associated costs) are warranted. Using Patient's Own Medication during hospitalisation might decrease medication wastage and associated costs. Objective To study the economic impact of patient's own medication use on medication waste and hospital staff's time spent during hospitalisation. Setting In seven Dutch hospitals, of which university, teaching, general, and specialised hospitals, eight different hospital wards, surgical and medical, were selected. Method In this prospective pre-post intervention study data on the economic value of medication waste and time spent by healthcare professionals were collected for a 2 months period each. The economic value of medication waste was defined as the value (€) of wasted medication per 100 patient days. For each ward, time spent on medication process activities was measured 10 times per staff member. The average time spent (in hours) on medication process steps (multiple activities) per staff member per 100 patients and associated salary costs were calculated for both periods. Main outcome measure The primary outcome of the study was the total economic value (€) of wasted medication per 100 patient days. Results Implementation of Patient's Own Medication decreased the economic value of wasted medication by 39.5% from €3983 to €2411 per 100 patient days. The mean time spent on the total medication process was reduced with 5.2 h per 100 patients (from 112.7 to 104.4 h per 100 patients). We observed a shift in professional activities, as physicians and nurses spent less time on the medication process, whereas pharmacy technicians had a greater role in it. When time spent was expressed as salary; €1219 could be saved per 100 patients. Conclusions This study showed that 'Patient's Own Medication' implementation may have a positive economic impact, as the value of medication waste decreases, hospital staff devoted less time on the medication process, and staff deployment is more efficient.

Aim: To evaluate the level of efficiency of public acute hospitals situated in the region of Murcia (Spain). Materials & methods: Data from nine acute general hospitals of Murcia's Health Service (SMS by its Spanish acronym) were analyzed over the 2012-2014 period. The data were extracted from the In-patient Health Establishment Statistics of the Ministry of Health, Social Services and Equality, from the National Health Service (SNS) portal and the SMS portal. To this end, the data envelopment analysis (DEA)-window method was used, since this extension of the basic DEA model allows to compare the efficiency of a small number of units over different years and analyze changes in efficiency over time. In addition, the model was complemented by smooth bootstrapping and a superefficiency analysis to improve the quality of the data interpretation. Four inputs were used (number of beds, number of operating rooms, personnel costs and operating costs), two undesirable outputs (average stay and rate of return) and three desirable outputs (weighted discharges, emergencies and surgical interventions). Results: The average level of inefficiency was 1.58% over the study period, with a good evolution between 2012 (3.53%) and 2014 (0.20%). This improvement was also reflected in the number of efficient hospitals that rose from two in 2012 to eight in 2014. Moreover, the slack levels detected were small. Conclusion: The management of the public hospitals analyzed was favorable, both regarding average level of efficiency and the number of hospitals qualified as efficient. However, the analysis revealed several ways to increase efficiency by reducing specific inputs and nondesirable outputs (mainly operating and personnel costs as well as average length of stay) while increasing desirable outputs (mostly the number of surgical interventions). To finish, specific policy measures are suggested to improve the performance of these hospitals.

Background: The recent introduction of an entirely subcutaneous implantable cardioverter-defibril-lator (S-ICD) represents an important progress in the defibrillation technology towards a less invasive approach. This is a single-center observational study of S-ICD implantations in Poland., Methods: The S-ICD was implanted in 11 patients with standard indications for an ICD. Patients in whom the device was implanted were evaluated for adverse events and device function at hospital discharge. All hospitalization costs were calculated and summed up for all patients. Costs were divided into following categories: medical materials, pharmaceuticals, operating theatre staff, cardiology depart-ment staff, laboratory tests, non-laboratory tests and additional non-medical costs., Results: The mean age of patients was 51.6 ± 16.4 years, 9 were men and 2 were women. Four pa-tients had atrial fibrillation as the basal rhythm, 1 patient had atrial flutter and 6 patients had sinus rhythm. All patients had at least one condition that precluded the use of a traditional ICD system or the S-ICD was preferred due to other conditions, i.e. a history complicated transvenous ICD therapy (18%), anticipated higher risk of infection (27%), lack or difficult vascular access (18%), young age and anticipated high cumulated risk of lifetime device therapy (36%). The mean duration of the im-plantation procedure was 2 h. One patient developed a postoperative pocket hematoma. Mean total time of hospitalization was 28 (6-92) days. Average cost of hospitalization per patient was 21,014.29 EUR (minimal = 19,332.71 EUR and maximal = 24,824.14 EUR)., Conclusions: S-ICD implantation appears to provide a viable alternative to transvenous ICD, espe-cially for patients without pacing requirements.

Purpose: Results of a study to determine time and cost requirements for final preparation of continuous renal replacement therapy (CRRT) products are reported., Methods: A 3-phase observational study was conducted at a tertiary care university hospital to evaluate costs associated with manual addition of phosphate and/or potassium to 3 commercial 5-L CRRT products. In the first phase of the study, pharmacy workflow processes for solution preparation were established; in the second phase, pharmacist and pharmacy technician time spent in the CRRT workflow and all materials used were observed and recorded. In the third phase, time and personnel requirements were analyzed in economic terms to estimate final preparation costs., Results: Through direct observation over 35 days, the CRRT workflow was observed and work times recorded for 511 bag preparations. The main cost contributors were the base CRRT solution and electrolyte additive prices. Technician compounding time differed substantially by solution brand and the need for electrolyte addition. Pharmacist verification time did not differ meaningfully by product., Conclusion: Preparation and verification of premade CRRT solutions that contained physiological electrolyte concentrations required less technician and pharmacist time than solutions that needed addition of electrolytes in the pharmacy. Personnel costs, which were a small part of the total cost of dispensed CRRT bags, were higher for technicians than pharmacists. The baseline costs of the solutions and the electrolyte additives, if needed, were the main contributors to total cost., (Copyright © 2018 by the American Society of Health-System Pharmacists, Inc. All rights reserved.)

Purpose:  Calculation of process-orientated costs for inpatient endovascular treatment of peripheral artery disease (PAD) from an interventional radiology (IR) perspective. Comparison of revenue situations in consideration of different ways to calculate internal treatment charges (ITCs) and diagnosis-related groups (DRG) for an independent IR department., Materials and Methods:  Costs (personnel, operating, material, and indirect costs) for endovascular treatment of PAD patients in an inpatient setting were calculated on a full cost basis. These costs were compared to the revenue situation for IR for five different scenarios: 1) IR receives the total DRG amount. IR receives the following DRG shares using ITCs based on InEK shares for 2) "Radiology" cost center type, 3) "OP" cost center type, 4) "Radiology" and "OP" cost center type, and 5) based on DKG-NT (scale of charges of the German Hospital Society)., Results:  78 patients (mean age: 68.6 ± 11.4y) with the following DRGs were evaluated: F59A (n = 6), F59B (n = 14), F59C (n = 20) and F59 D (n = 38). The length of stay for these DRG groups was 15.8 ± 12.1, 9.4 ± 7.8, 2.8 ± 3.7 and 3.4 ± 6.5 days Material costs represented the bulk of all costs, especially if new and complex endovascular procedures were performed. Revenues for neither InEK shares nor ITCs based on DKG-NT were high enough to cover material costs. Contribution margins for the five scenarios were 1 = € 1,539.29, 2 = € -1,775.31, 3 = € -2,579.41, 4 = € -963.43, 5 = € -2,687.22 in F59A, 1 = € -792.67, 2 = € -2,685.00, 3 = € -2,600.81, 4 = € -1,618.94, 5 = € -3,060.03 in F59B, 1 = € -879.87, 2 = € -2,633.14, 3 = € -3,001.07, 4 = € -1,952.33, 5 = € -3,136.24 in F59C and 1 = € 703.65, 2 = € -106.35, 3 = € -773.86, 4 = € 205.14, 5 = € -647.22 in F59 D. InEK shares return on average € 150 - 500 more than ITCs based on the DKG-NT catalog., Conclusion:  In this study positive contribution margins were seen only if IR receives the complete DRG amount. InEK shares do not cover incurred costs, with material costs representing the main part of treatment costs. Internal treatment charges based on the DKG-NT catalog provide the worst cost coverage., Key Points:   · Internal treatment charges based on the DKG-NT catalog provide the worst cost coverage for interventional radiology at our university hospital.. · Shares from the InEK matrix such as the cost center "radiology" or "OP" as revenue for IR are not sufficient to cover incurred costs. A positive contribution margin is achieved only in the case of a compensation method in which IR receives the total DRG amount.., Citation Format: · Vogt FM, Hunold P, Haegele J et al. Comparison of the Revenue Situation in Interventional Radiology Based on the Example of Peripheral Artery Disease in the Case of a DRG Payment System and Various Internal Treatment Charges. Fortschr Röntgenstr 2017; 190: 348 - 357., Competing Interests: Disclosure The authors report no conflicts of interest in this work., (© Georg Thieme Verlag KG Stuttgart · New York.)

Objectives: This research assesses the use of Radio Frequency Identification (RFID) technologies as an alternative for insurance costs in hospitals., Methods: Despite the advantages of RFID, this technology has not been applied in most hospitals due to implementation costs and amortization of RFID. In this paper, we intend to model the total profit of hospitals in three scenarios namely, application of RFID technology in the hospital, without applying RFID technology in the hospital and insuring patients and equipment in the hospital., Results: We analyzed the aforementioned situations over a period of time to find out how they affect the profit of the hospital. Based on this analysis we concluded that if applying RFID technology is costly, it will be feasible for advanced hospitals with more beds. In the scenario of insuring patients and equipment, if insurance organization takes over a small portion of the cost of the mistakes and oversights, insuring patients and equipment will not be feasible for the hospital, and it is better to apply RFID technology Instead., Conclusions: RFID is among the technologies applied to reduce mistakes of the personnel in hospitals. Moreover, applying this technology has led to a decrease in the number of personnel required in hospitals. This study models total profit of hospitals in three aforementioned scenarios. Based on analyzing these models we conclude that if applying RFID technology is costly, it will be feasible for advanced hospitals with more beds.

Aim: to estimate the direct variable costs of the topical treatment of stages III and IV pressure injuries of hospitalized patients in a public university hospital, and assess the correlation between these costs and hospitalization time., Materials and Methods: Forty patients of both sexes who had been admitted to the São Paulo Hospital, São Paulo, SP, Brazil, from 2011 to 2012, with pressure injuries in the sacral, ischial or trochanteric region were included. The patients had a total of 57 pressure injuries in the selected regions, and the lesions were monitored daily until patient release, transfer or death. The quantities and types of materials, as well as the amount of professional labor time spent on each procedure and each patient were recorded. The unit costs of the materials and the hourly costs of the professional labor were obtained from the hospital's purchasing and human resources departments, respectively. Spearman's correlation coefficient and the Mann-Whitney and Kruskal-Wallis tests were used for the statistical analyses., Results: The mean topical treatment costs for stages III and IV PIs were significantly different (US$ 854.82 versus US$ 1785.35; p = 0.004). The mean topical treatment cost of stages III and IV pressure injuries per patient was US$ 1426.37. The mean daily topical treatment cost per patient was US$ 40.83. There was a significant correlation between hospitalization time and the total costs of labor and materials (p < 0.05). There was no significant difference between hospitalization time periods for stages III and IV pressure injuries (40.80 days and 45.01 days, respectively; p = 0.834)., Conclusion: The mean direct variable cost of the topical treatment for stages III and IV pressure injuries per patient in this public university hospital was US$ 1426.37., (Copyright © 2016. Published by Elsevier Ltd.)

OBJECTIVE To assess resource allocation and costs associated with US hospitals preparing for the possible spread of the 2014-2015 Ebola virus disease (EVD) epidemic in the United States. METHODS A survey was sent to a stratified national probability sample (n=750) of US general medical/surgical hospitals selected from the American Hospital Association (AHA) list of hospitals. The survey was also sent to all children's general hospitals listed by the AHA (n=60). The survey assessed EVD preparation supply costs and overtime staff hours. The average national wage was multiplied by labor hours to calculate overtime labor costs. Additional information collected included challenges, benefits, and perceived value of EVD preparedness activities. RESULTS The average amount spent by hospitals on combined supply and overtime labor costs was $80,461 (n=133; 95% confidence interval [CI], $56,502-$104,419). Multivariate analysis indicated that small hospitals (mean, $76,167) spent more on staff overtime costs per 100 beds than large hospitals (mean, $15,737; P<.0001). The overall cost for acute-care hospitals in the United States to prepare for possible EVD cases was estimated to be $361,108,968. The leading challenge was difficulty obtaining supplies from vendors due to shortages (83%; 95% CI, 78%-88%) and the greatest benefit was improved knowledge about personal protective equipment (89%; 95% CI, 85%-93%). CONCLUSIONS The financial impact of EVD preparedness activities was substantial. Overtime cost in smaller hospitals was >3 times that in larger hospitals. Planning for emerging infectious disease identification, triage, and management should be conducted at regional and national levels in the United States to facilitate efficient and appropriate allocation of resources in acute-care facilities. Infect Control Hosp Epidemiol 2017;38:405-410.

After the implementation of the multidisciplinary geriatric hip fracture clinical pathway in 2007, the hospital length of stay and the clinical outcomes improves. Moreover, the cost of manpower for each hip fracture decreases. It proves that this care model is cost-effective., Introduction: The objective of this study is to compare the clinical outcomes and the cost of manpower before and after the implementation of the multidisciplinary geriatric hip fracture clinical pathway (GHFCP)., Methods: The hip fracture data from 2006 was compared with the data of four consecutive years since 2008. The efficiency of the program is assessed using the hospital length of stay. The clinical outcomes include mortality rates and complication rates are compared. Cost of manpower was also analysed., Results: After the implementation of the GHFCP, the preoperative length of stay shortened significantly from 5.8 days in 2006 to 1.3 days in 2011. The total length of stay in both acute and rehabilitation hospitals were also shortened by 6.1 days and 14.2 days, respectively. The postoperative pneumonia rate also decreased from 1.25 to 0.25%. The short- and long-term mortalities also showed a general improvement. Despite allied health manpower was increased to meet the increased workload, the shortened length of stay accounted for a mark decrease in cost of manpower per hip fracture case., Conclusion: This study proves that the GHFCP shortened the geriatric hip fracture patients' length of stay and improves the clinical outcomes. It is also cost-effective which proves better care is less costly.

Sitter pay ranges from $11 to $40 an hour, while the cost to use AvaSure is under $3 an hour per patient, Brad Playford said.

Purpose: The direct cost to the National Health Service (NHS) in England of pars plana vitrectomy (PPV) is unknown since a bottom-up costing exercise has not been undertaken. Healthcare resource group (HRG) costing relies on a top-down approach. We aimed to quantify the direct cost of intermediate complexity PPV., Methods: Five NHS vitreoretinal units prospectively recorded all consumables, equipment and staff salaries during PPV undertaken for vitreomacular traction, epiretinal membrane and macular hole. Out-of-surgery costs between admission and discharge were estimated using a representative accounting method., Results: The average patient time in theatre for 57 PPVs was 72 min. The average in-surgery cost for staff was £297, consumables £619, and equipment £82 (total £997). The average out-of-surgery costs were £260, including nursing and medical staff, other consumables, eye drops and hospitalisation. The total cost was therefore £1634, including 30 % overheads. This cost estimate was an under-estimate because it did not include out-of-theatre consumables or equipment. The average reimbursed HRG tariff was £1701., Conclusions: The cost of undertaking PPV of intermediate complexity is likely to be higher than the reimbursed tariff, except for hospitals with high throughput, where amortisation costs benefit from economies of scale. Although this research was set in England, the methodology may provide a useful template for other countries., Competing Interests: Compliance with ethical standards Conflicts of interest Some of the results from this research were presented at the International ISPOR Conference in New Orleans, May 2013. Thrombogenics provided funding to undertake this study, including financial support to attend the ISPOR Conference. T.J. is a Consultant to Bausch and Lomb, and Thrombogenics and a paid speaker for DORC.

Introduction: We aim to outline the annual cost of setting up and running a standard, local, multi-professional obstetric emergencies training course, PROMPT (PRactical Obstetric Multi-Professional Training), at Southmead Hospital, Bristol, UK - a unit caring for approximately 6500 births per year., Material and Methods: A retrospective, micro-costing analysis was performed. Start-up costs included purchasing training mannequins and teaching props, printing of training materials and assembly of emergency boxes (real and training). The variable costs included administration time, room hire, additional printing and the cost of releasing all maternity staff in the unit, either as attendees or trainers. Potential, extra start-up costs for maternity units without established training were also included., Results: The start-up costs were €5574 and the variable costs for 1 year were €143 232. The total cost of establishing and running training at Southmead for 1 year was €148 806. Releasing staff as attendees or trainers accounted for 89% of the total first year costs, and 92% of the variable costs. The cost of running training in a maternity unit with around 6500 births per year was approximately €23 000 per 1000 births for the first year and around €22 000 per 1000 births in subsequent years., Conclusions: The cost of local, multi-professional obstetric emergencies training is not cheap, with staff costs potentially representing over 90% of the total expenditure. It is therefore vital that organizations consider the clinical effectiveness of local training packages before implementing them, to ensure the optimal allocation of finite healthcare budgets., (© 2016 Nordic Federation of Societies of Obstetrics and Gynecology.)

The difficult financial situation in German hospitals requires measures for improvement in process quality. Associated increases in revenues in the high income field "operating room (OR) area" are increasingly the responsibility of OR management but it has not been shown that the introduction of an efficiency-oriented management leads to an increase in process quality and revenues in the operating theatre. Therefore the performance in the operating theatre of the University Medical Center Göttingen was analyzed for working days in the core operating time from 7.45 a.m. to 3.30 p.m. from 2009 to 2014. The achievement of process target times for the morning surgery start time and the turnover times of anesthesia and OR-nurses were calculated as indicators of process quality. The number of operations and cumulative incision-suture time were also analyzed as aggregated performance indicators. In order to assess the development of revenues in the operating theatre, the revenues from diagnosis-related groups (DRG) in all inpatient and occupational accident cases, adjusted for the regional basic case value from 2009, were calculated for each year. The development of revenues was also analyzed after deduction of revenues resulting from altered economic case weighting. It could be shown that the achievement of process target values for the morning surgery start time could be improved by 40 %, the turnover times for anesthesia reduced by 50 % and for the OR-nurses by 36 %. Together with the introduction of central planning for reallocation, an increase in operation numbers of 21 % and cumulative incision-suture times of 12% could be realized. Due to these additional operations the DRG revenues in 2014 could be increased to 132 % compared to 2009 or 127 % if the revenues caused by economic case weighting were excluded. The personnel complement in anesthesia (-1.7 %) and OR-nurses (+2.6 %) as well as anesthetists (+6.7 %) increased less compared to the revenues or were slightly reduced. This improvement in process quality and cumulative incision-suture times as well as the increase in revenues, reflect the positive impact of an efficiency-oriented central OR management. The OR management releases due to measures of process optimization the necessary personnel and time resources and therefore achieves the basic prerequisites for increased revenues of surgical disciplines. The method presented can be used by other hospitals as a guideline to analyze performance development.

Background: Patient blood management (PBM) is a multidisciplinary approach focusing on the diagnosis and treatment of preoperative anaemia, the minimisation of blood loss, and the optimisation of the patient-specific anaemia reserve to improve clinical outcomes. Economic aspects of PBM have not yet been sufficiently analysed., Objectives: The aim of this study is to analyse the costs associated with the clinical principles of PBM and the project costs associated with the implementation of a PBM program from an institutional perspective., Materials and Methods: Patient-related costs of materials and services were analysed at the University Hospital Frankfurt for 2013. Personnel costs of all major processes were quantified based on the time required to perform each step. Furthermore, general project costs of the implementation phase were determined., Results: Direct costs of transfusing a single unit of red blood cells can be calculated to a minimum of €147.43. PBM-associated costs varied depending on individual patient requirements. The following costs per patient were calculated: diagnosis of preoperative anaemia €48.69-123.88; treatment of preoperative anaemia (including iron-deficiency anaemia and megaloblastic anaemia) €12.61-127.99; minimising perioperative blood loss (including point-of-care diagnostics, coagulation management and cell salvage) €3.39-1,901.81; and costs associated with the optimisation of the tolerance to anaemia (including patient monitoring and volume therapy) €28.62. General project costs associated with the implementation of PBM were €24,998.24., Conclusions: PBM combines various alternatives to the transfusion of red blood cells and improves clinical outcome. Costs of PBM vary from institution to institution and depend on the extent to which different aspects of PBM have been implemented. The quantification of costs associated with PBM is essential in order to assess the economic impact of PBM, and thereby, to efficiently re-allocate health care resources. Costs were determined at a single university hospital. Thus, further analyses of both the costs of transfusion and the costs of PBM-principles will be necessary to evaluate the cost-effectiveness of PBM.

Introduction: The aim of this study was to analyse the hospital cost of treatment with robotic-assisted laparoscopic hysterectomy and total abdominal hysterectomy for women with endometrial cancer or atypical complex hyperplasia and to identify differences in resource use and cost., Material and Methods: This cost analysis was based on two cohorts: women treated with robotic-assisted laparoscopic hysterectomy (n = 202) or with total abdominal hysterectomy (n = 158) at Copenhagen University Hospital, Herlev, Denmark. We conducted an activity-based cost analysis including consumables and healthcare professionals' salaries. As cost-drivers we included severe complications, duration of surgery, anesthesia and stay at the post-anesthetic care unit, as well as number of hospital bed-days. Ordinary least-squares regression was used to explore the cost variation. The primary outcome was cost difference in Danish kroner between total abdominal hysterectomy and robotic-assisted laparoscopic hysterectomy., Results: The average cost of consumables was 12,642 Danish kroner more expensive per patient for robotic-assisted laparoscopic hysterectomy than for total abdominal hysterectomy (2014 price level: 1€ = 7.50 Danish kroner). When including all cost-drivers, the analysis showed that the robotic-assisted laparoscopic hysterectomy procedure was 9386 Danish kroner (17%) cheaper than the total abdominal hysterectomy (p = 0.003). When the robot investment was included, the cost difference reduced to 4053 Danish kroner (robotic-assisted laparoscopic hysterectomy was 7% cheaper than total abdominal hysterectomy) (p = 0.20). Increasing age and Type 2 diabetes appeared to influence the overall costs., Conclusion: For women with endometrial cancer or atypical complex hyperplasia, robotic-assisted laparoscopic hysterectomy was cheaper than total abdominal hysterectomy, mostly due to fewer complications and shorter length of hospital stay., (© 2015 Nordic Federation of Societies of Obstetrics and Gynecology.)

We propose a mathematical programming formulation that incorporates annualized hours and shows to be very flexible with regard to modeling various contract types. The objective of our model is to minimize salary cost, thereby covering workforce demand, and using annualized hours. Our model is able to address various business questions regarding tactical workforce planning problems, e.g., with regard to annualized hours, subcontracting, and vacation planning. In a case study for a Dutch hospital two of these business questions are addressed, and we demonstrate that applying annualized hours potentially saves up to 5.2% in personnel wages annually.

Every year, the American Hospital Association compiles the Environmental Scan to provide hospital leaders with insight and information about market forces that are likely to affect the health care field. One common theme this year is the pace of change.

Objective: To evaluate the impact of a pilot workplace health partner intervention delivered by a predictive health institute to university and academic medical center employees on per-member, per-month health care expenditures., Methods: We analyzed the health care claims of participants versus nonparticipants, with a 12-month baseline and 24-month intervention period. Total per-member, per-month expenditures were analyzed using two-part regression models that controlled for sex, age, health benefit plan type, medical member months, and active employment months., Results: Our regression results found no statistical differences in total expenditures at baseline and intervention. Further sensitivity analyses controlling for high cost outliers, comorbidities, and propensity to be in the intervention group confirmed these findings., Conclusions: We find no difference in health care expenditures attributable to the health partner intervention. The intervention does not seem to have raised expenditures in the short term.

Objective: The aim of this study was to evaluate the cost of an operating room using data from our hospital. Using an accounting-based method helped us., Methods: Over the year 2012, the sum of direct and indirect expenses with cost sharing expenses allowed us to calculate the cost of the operating room (OR) and of the post-anaesthesia care unit (PACU)., Results: The cost of the OR and PACU was €10.8 per minute of time offered. Two thirds of the direct expenses were allocated to surgery and one third to anaesthesia. Indirect expenses were 25% of the direct expenses. The cost of medications and single use medical devises was €111.45 per anaesthesia. The total cost of anaesthesia (taking into account wages and indirect expenses) was €753.14 per anaesthesia as compared to the total cost of the anaesthesia. The part of medications and single use devices for anaesthesia was 14.8% of the total cost., Conclusion: Despite the difficulties facing cost evaluation, this model of calculation, assisted by the cost accounting controller, helped us to have a concrete financial vision. It also shows that a global reflexion is necessary during financial decision-making., (Copyright © 2015 Société française d’anesthésie et de réanimation (Sfar). Published by Elsevier Masson SAS. All rights reserved.)

Aim: Hip fracture management in a dedicated geriatric perioperative unit improves long-term mortality. In this "we report the" health economics evaluation of this geriatric perioperative care unit (UPOG)., Methods: This study was conducted in 2011. Direct expenditures were obtained from the Assistance Publique-Hopitaux de Paris database, indirect expenditures from the hospital cost accounting,and financial incomes from the PMSI Pilot programme. Emergency department incomes and expenditures were estimated together with additional incomes related to orthopaedic surgery. We estimated expenditures related to operating room (OR) activities in the framework of several models, one with an emergency OR open 24h/24, and one with a standard OR. Lastly, we compared incomes/expenditures according to regular paramedical staff or according to the paramedical staff that would appear to be necessary to ensure patient care., Results: 253 patients were admitted to the UPOG during the study J215 (84%) of whom underwent surgery. The income statement was positive for both an emergency OR (+741,000 Euros) and a standard OR ( +490,000 Euros) and remained positive when paramedical staff was increased (+629,000 and +156,000 Euros, respectively)., Conclusion: The UPOG income statement shows a positive result regardless of the model used, emergency 24h/24 OR or standard OR, and even when paramedical staff is increased

Purpose: The purpose of this paper is to investigate the relationship between permanent tensions and organizational change., Design/methodology/approach: This study used paradox theory and a case study. The case organization is a public university hospital in Finland involving several stakeholders., Findings: The analysis suggests that the relationship between permanent tensions and organizational change is a paradox that is part of organizational reality. As an organization learns to live with its permanent tensions, the renewal paradox settles into equilibrium. When tensions are provoked, the paradox is disturbed until it finds a new balance. This flexible nature of the paradox is the force that keeps the different stakeholders simultaneously empowered to maintain their unique missions and cohesive in order to benefit from the larger synergy., Practical Implications: This research suggests that identification and evaluation of each permanent tension within an organization is important when executing organizational change. The fact that certain tensions are permanent and cannot be solved may have an influence on how planned change initiatives are executed. The results show that permanent tensions may be harnessed for the benefit of an organizational change., Originality/value: This research demonstrates originality by offering an alternative view of tensions, a view which emphasizes not only their permanent and plural nature but their importance for enabling the organization to change at its own, non-disruptive pace. The research also proposes a new concept, the "renewal paradox", to enhance understanding of the relationship between permanent tensions and organizational change.

Setting: Ioannina University Hospital, Ioannina, Greece., Objective: To evaluate the value of adding an interferon-gamma release assay (IGRA) to the tuberculin skin test (TST) for detecting latent tuberculous infection (LTBI) in a Greek university hospital among health care workers (HCWs) predominantly vaccinated with bacille Calmette-Guérin (BCG)., Design: Of 788 HCWs enrolled, 68.1% were BCG-vaccinated. A TST ⩾ 10 mm was considered positive and was followed by the QuantiFERON-TB(®) Gold In-Tube assay (QFT-GIT) in a two-step strategy., Results: Of the enrolled HCWs, 36.4% were TST-positive, of whom only 14.4% were IGRA-positive. Agreement between the tests was poor (κ = 0.019; 95%CI -0.014-0.05, P = 0.355). Both TST and IGRA positivity increased with TST diameter, from 5.7% in TST 10-14 mm to 48.8% in TST ⩾20 mm. TST-positive, IGRA-negative results were most likely in younger, recently BCG-vaccinated HCWs (84.6% in those aged 20-29 years) and less likely in older HCWs (45% in those aged 50-59 years). The two-step strategy would have been more cost saving compared to the TST-only approach if adherence to LTBI treatment in our cohort had been ⩾24%., Conclusions: Poor overall agreement between TST and QFT-GIT was found. Use of IGRA as a second step in TST-positive cases offers an appropriate tool for LTBI detection among BCG-vaccinated HCWs in low-TB-incidence settings.

Objectives: We had for aim to determine the characteristics of carbapenemase-producing enterobacteria (CPE) carriers and to assess the economic impact of isolation measures leading to loss of activity (closed beds, prolonged hospital stays) and additional personnel hours., Patients and Methods: We conducted a retrospective study for 2years (2012/2013), in a French general hospital, focusing on CPE carriers with clinical case description. The costs were estimated by comparing the activity of concerned units (excluding the ICU) during periods with CPE carriers or contacts, during the same periods of the year (n-1), plus additional hours and rectal swabs., Results: Sixteen EPC carriers were identified: 10 men and 6 women, 65±10years of age. Seven patients acquired EPC in hospital during 2 outbreaks in 2012. Four patients presented with an infection (peritonitis, catheter infection, and 2 cases of obstructive pyelonephritis) with a favorable outcome. The median length of stay was 21days [4,150]. Six patients died, 1 death was indirectly due to CPE because of inappropriate empiric antibiotic therapy. A decrease in activity was observed compared to the previous year with an estimated 547,303€ loss. The 1779 additional hours cost 63,870€, and 716 screening samples cost 30,931€. The total additional cost was estimated at 642,104€ for the institution., Conclusions: Specialized teams for CPE carriers and isolation of contact patients, required to avoid/control epidemics, have an important additional cost. An appreciation of their support is needed, as well as participation of rehabilitation units., (Copyright © 2014 Elsevier Masson SAS. All rights reserved.)

Objective: To compare the costs related to the clinical effectiveness of general anesthesia versus spinal anesthesia in inguinal hernioplasty ambulatory surgery., Material and Methods: An observational, retrospective cohort study measurement and analysis of cost-effectiveness, in the ambulatory surgery unit of a general hospital. All patients over 18 years of age diagnosed with primary inguinal hernia and scheduled for unilateral hernioplasty between January 2010 and December 2011 were included. Duration of anesthetic induction, length of stay in both the operating room, and in the post-anesthesia care unit, the anesthetic effectiveness (the incidence of adverse effects and the patient's comfort level), and variable economic costs associated with the use of drugs, as well as the use of human resources, were compared., Results: The final analysis included 218 patients, 87.2% male, with a mean age of 53 years (range: 18-85 years). Of these, 139 (63.76%) received subarachnoid anesthesia and 79,(36.2%) general anesthesia. The length of time a patient remained in the post-anesthesia care unit was 337.6±160.2min in the subarachnoid anesthesia group, and 210.0±97.5min for the general anesthesia group (P<.001). Costs of drugs for general anesthesia were higher than that for subarachnoid anesthesia (86.2±8.3 vs. 18.7±7.2). The total cost difference between the 2 techniques was €115.8 more for subarachnoid anesthesia (P<.001)., Conclusions: Both techniques showed similar effectiveness. The overall costs for subarachnoid anesthesia were greater than for the general. The cost-effectiveness of general anesthesia is better for outpatient inguinal hernia repair surgery., (Copyright © 2013 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Published by Elsevier España. All rights reserved.)

Background: Percutaneous coronary interventions (PCI) are widespread procedures in the Italian Healthcare System, but concerns are raised about their economic sustainability. In the last decade, public hospitals have outsourced the PCI services (building and maintaining the technological instruments and the personnel) "buying" them from private companies (Buy) rather than building and maintaining them through public expenditure (Make). The aim of this study was to compare the economic and clinical impact of these two management solutions (Buy and Make) in two community hospitals located in the Turin metropolitan area (Italy)., Methods: We conducted: 1) a quantitative assessment in order to compare differences in the economic impact between Buy and Make for providing PCI; 2) a qualitative assessment comparing the clinical characteristics of two inpatient populations undergoing PCI and then analyzing the efficacy of the procedure in-hospital and at 6-month follow-up., Results: Between January and June 2010, a total of 332 patients underwent PCI at the "degli Infermi" Hospital in Rivoli and 340 at the "Maria Vittoria" Hospital in Turin (Italy). There were no significant differences between the two populations neither about the clinical characteristics nor in procedural efficacy (either immediate or at follow-up). For 600 units of diagnostic-therapeutic pathway, the net present value at a discount rate of 3.5% of the Make project is higher than that of the Buy by €278.402,25, and is therefore the less convenient of the two solutions. The Buy solution is still the more convenient of the two at volumes <700 units., Conclusions: Our findings show that the Buy solution, if tailored to the specific local needs, provides access to sophisticated technology without making worse quality of services and may save capital expenditure below 700 PCI/years.

Purpose: To determine the "real cost" of conventional transarterial chemoembolization in the treatment of patients with unresectable hepatocellular carcinoma (HCC)., Materials and Methods: Comprehensive cost data for performance of conventional transarterial chemoembolization were calculated from a retrospective review of records of 50 consecutive outpatient transarterial chemoembolization procedures in 36 patients with HCC. Costs included labor, equipment, facility acquisition and maintenance, overhead, and administrative costs in a single academic medical center. Hourly rate operational costs for the angiography suite and recovery area were calculated, to which the consumable supply costs were added. Conventional transarterial chemoembolization was defined as selective intrahepatic administration of chemotherapeutic agents (doxorubicin and mitomycin C) emulsified in ethiodized oil (Lipiodol)., Results: The hourly rate to operate an angiography suite at the institution was calculated to be $539/h. Recovery time was calculated at $108/h. Median overall cost of conventional transarterial chemoembolization was $3,269 (range, $2,223-$5,654). This overall cost comprised median room and personnel costs of $763 (range, $404-$1,797), consumable costs of $1,886 (range, $1,134-$4,126), and recovery costs of $378 (range, $162-$864)., Conclusions: The largest contribution (62%) to the real cost of outpatient transarterial chemoembolization comes from the expendable equipment used in the procedure. The angiography suite and personnel costs constitute 25% of the total, and recovery costs constitute 13%. This finding is a change from previous reports in which angiography suite operation was the greatest contributor to cost. Understanding real cost is an essential step in determining the value of the procedure., (Published by Elsevier Inc.)

Background: Changes in resident duty hours in Europe and North America have had a major impact on the internal organizational dynamics of health care organizations. This paper examines, and assesses the impact of, organizational interventions that were a direct response to these duty hour reforms., Methods: The academic literature was searched through the SCOPUS database using the search terms "resident duty hours" and "European Working Time Directive," together with terms related to organizational factors. The search was limited to English-language literature published between January 2003 and January 2012. Studies were included if they reported an organizational intervention and measured an organizational outcome., Results: Twenty-five articles were included from the United States (n=18), the United Kingdom (n=5), Hong Kong (n=1), and Australia (n=1). They all described single-site projects; the majority used post-intervention surveys (n=15) and audit techniques (n=4). The studies assessed organizational measures, including relationships among staff, work satisfaction, continuity of care, workflow, compliance, workload, and cost. Interventions included using new technologies to improve handovers and communications, changing staff mixes, and introducing new shift structures, all of which had varying effects on the organizational measures listed previously., Conclusions: Little research has assessed the organizational impact of duty hour reforms; however, the literature reviewed demonstrates that many organizations are using new technologies, new personnel, and revised and innovative shift structures to compensate for reduced resident coverage and to decrease the risk of limited continuity of care. Future research in this area should focus on both micro (e.g., use of technology, shift changes, staff mix) and macro (e.g., culture, leadership support) organizational aspects to aid in our understanding of how best to respond to these duty hour reforms.

Background: Measures to protect healthcare workers where there is risk of injury or infection from medical sharps became mandatory in the European Union (EU) from May 2013. Our research objective was to estimate the net budget impact of introducing safety-engineered devices (SEDs) for prevention of needlestick injuries (NSIs) in a Belgian hospital., Methods: A 5-year incidence-based budget impact model was developed from the hospital inpatient perspective, comparing costs and outcomes with SEDs and prior-used conventional (non-safety) devices. The model accounts for device acquisition costs and costs of NSI management in 4 areas of application where SEDs are currently used: blood collection, infusion, injection and diabetes insulin administration. Model input data were sourced from the Institut National d'Assurance Maladie-Invalidité, published studies, clinical guidelines and market research. Costs are discounted at 3%., Results: For a 420-bed hospital, 100% substitution of conventional devices by SEDs is estimated to decrease the cumulative 5-year incidence of NSIs from 310 to 75, and those associated with exposure to blood-borne viral diseases from 60 to 15. Cost savings from managing fewer NSIs more than offset increased device acquisition costs, yielding estimated 5-year overall savings of €51,710. The direction of these results is robust to a range of sensitivity and model scenario analyses. The model was most sensitive to variation in the acquisition costs of SEDs, rates of NSI associated with conventional devices, and the acquisition costs of conventional devices., Conclusions: NSIs are a significant potential risk with the use of sharp devices. The incidence of NSIs and the costs associated with their management can be reduced through the adoption of safer work practices, including investment in SEDs. For a Belgian hospital, the budget impact model reports that the incremental acquisition costs of SEDs are offset by the savings from fewer NSIs. The availability of more robust data for NSI reduction rates, and broadening the scope of the model to include ancillary measures for hospital conversion to SED usage, outpatient and paramedic device use, and transmission of other blood-borne diseases, would strengthen the model.

Background: A primary determinant of value in treating appendicitis is inpatient cost. The purpose of this study was to identify hospital-level factors that drive costs associated with the treatment of appendicitis., Methods: Cost-to-charge ratios from the 2009 Kids' Inpatient Database gave average all-payer costs by hospital for uncomplicated appendicitis (without peritonitis, ICD-9-CM 540.9) and complicated appendicitis (generalized peritonitis, 540.0; peritoneal abscess, 540.1). The 10% of hospitals with the lowest costs were defined as low cost; the remaining 90% were defined non-low cost. Bivariate and multivariate analyses compared hospital characteristics between the two groups., Results: Threshold cost dividing low cost from non-low cost for uncomplicated appendicitis was $4626; for complicated appendicitis, it was $6,026. For both conditions teaching status, lower percentage of pediatric discharges, and fewer registered nurses (RN) per 1000 adjusted patient-days predicted a hospital to be low cost. A cost benefit for medium and large hospitals and higher inpatient volume was found only for uncomplicated appendicitis. Regional effects were noted., Conclusions: The findings show the high-cost structure of hospitals that care for high volumes of children, emphasizing the need to constrain cost. There is some benefit of economies of scale, and careful attention to the numbers of nursing personnel., (© 2013.)

Objective: Recommendations on difficult tracheal intubation constrain each surgical block to have a fiberscope available. Reusable fiberscope presents the problem of availability, the risk of non-conventional infections transmission and the cost. Single-use fiberscopes are presently available (Ambu® aScope™). This medico-economic study aims to assess the cost of using a reusable fiberscope as compared to the single use fiberscope., Study Design: Cost minimization analysis., Material: Reusable fiberscope Pentax® FB 15P (Pentax France, Argenteuil) and single-use fiberscope Ambu® aScope™ (Ambu A/S, Ballerup, Denmark)., Method: Minimization-cost analysis conducted between 2006 and 2012. The amortization cost per utilization for two reusable fiberscopes took into account the acquisition and maintenance costs, as well as the costs related to disinfection. The cost of the single use fiberscope was calculated according to its acquisition cost., Results: The total cost of the reusable material was 55,874€ over 6years, corresponding to a unitary cost of 206€ per fiberscopy. During this period, 780 sterilizations were carried out for a total cost of 32,611€. Acquisition and maintenance costs were respectively 18,382€ and 4880€. The cost of the single use fiberscope is of 200€ per fiberscopy., Conclusion: This medico-economic evaluation shows that the utilization cost of single use and reusable fiberscopes are very close. This should be analyzed at the light of some benefits of using single use devices for the difficult tracheal intubation., (Copyright © 2013 Société française d’anesthésie et de réanimation (Sfar). Published by Elsevier SAS. All rights reserved.)