Video vs Direct Laryngoscopy

Cost savings calculator

References
  1. Sherman JD, Raibley IV LA, Eckelman MJ. Life cycle assessment and costing methods for device procurement: comparing reusable and single-use disposable laryngoscopes. Anesthesia & Analgesia. 2018;127(2):434-443.
  2. Hansel J, Rogers AM, Lewis SR, Cook TM, Smith AF. Videolaryngoscopy versus direct laryngoscopy for adults undergoing tracheal intubation. Cochrane Database of Systematic Reviews. 2022;(4)
  3. Stone S. Decreasing Costs in the Operating Room by Utilizing the Best Laryngoscope for Direct Laryngoscopy. 2018; Doctoral Projects. 99.https://aquila.usm.edu/dnp_capstone/99
  4. Saunders S, Silas U, Saunders R, McNarry A. MT14 How Should Clinical Outcomes Factor Into Purchasing Decisions About Macintosh-Style Laryngoscopes? Value in Health. 2022;25(12):S380.
  5. Sakles JC, Chiu S, Mosier J, Walker C, Stolz U. The importance of first pass success when performing orotracheal intubation in the emergency department. Academic Emergency Medicine. 2013;20(1):71-78.
  6. Moucharite MA, Zhang J, Giffin R. Factors and economic outcomes associated with documented difficult intubation in the United States. ClinicoEconomics and Outcomes Research. 2021:227-239.
  7. Bhatti NI, Mohyuddin A, Reaven N, et al. Cost analysis of intubation-related tracheal injury using a national database. Otolaryngology—Head and Neck Surgery. 2010;143(1):31-36.
  8. Dewayne Whitener, “The Cost of Reuseable vs. Single-use larygngoscopes”(2012). Southeast Health, Cape Girardeau, Missouri. viewed on 02/06/2023 from https://pdf4pro.com/amp/view/the-cost-of-reusable-vs-single-use-laryngoscopes-4008e7.html.

Discover the Value of Video Laryngoscopy

See how much budget is available to invest in the McGRATH™ MAC video laryngoscope for routine intubation compared to direct laryngoscopy (DL).

With this calculator you will be able to estimate how much you spend with DL — including purchasing and running costs, as well as adverse event occurrence and associated costs resulting from the use of DL.

Input the average number of intubations performed monthly at your facility. The remaining calculator fields are pre-populated based on published literature and assumptions and can be adjusted as needed to represent your unique institution.

Clinical outcomes

A recent Cochrane Review demonstrates that video laryngoscopy (VL) is better than direct laryngoscopy (DL) for successful tracheal intubation and estimates first-pass success using DL at 93.5%.2 A re-analysis of the Cochrane review data was performed to specifically compare McGrath™ MAC versus Macintosh DL for perioperative endotracheal intubation.4 In other words, from the randomized controlled trials (RCTs) included in the Cochrane review, RCTs that compared McGRATH™ MAC VL with Macintosh DL in perioperative care were selected for a sub-group analysis. The outcomes assessed were: first-pass success, failed intubation, esophageal intubation, dental injury, and hypoxemia. Fourteen RCTs were included in the re-analysis with 3,137 patients (1,570 using McGRATH™ MAC VL). The following outcomes were used in this calculator to estimate the likelihood of occurrence of a clinical outcome with McGRATH™ MAC VL relative to DL.

Outcome when Using McGRATH™ MAC VL vs. DL Cochrane Review Re-Analysis4RR or OR [95% CI]
First pass success, RR 1.07 [1.01, 1.15] Statistically significant increase with McGrath™ MAC VL
Failed intubation, OR 0.33 [0.12, 0.92] Statistically significant reduction with McGrath™ MAC VL
Esophageal intubation, OR 0.23 [0.04, 1.15] Reduction (non-significant) with McGrath™ MAC VL

Cost and resource utilization

Acquisition and running cost of DL

  • Blade utilization and reprocessing costs could be estimated using the Yale-New Haven Hospital life cycle and costing comparison of stainless-steel reusable vs. single-use DL study by Sherman et al, 2018, with a maximum usage of 4000 times, blade and handles reprocessing costs of $2.10 (2.58, 2022 USD) and $2.39 (2.93, 2022 USD) respectively.1
  • An estimate of $20.86 for the costs of DL handles and $5.52 for the blades is provided by the cost minimization analysis of Stone et al. 2018, show in 2022 USD, assuming 10 handles and 20 blades per box.3

Cost of adverse events

  • To our knowledge there is no reference to inform the cost of failure to achieve first-pass success. Please use your best estimate.
  • The cost of failed intubation could be estimated using the cost of difficult intubation $14,468 (16,767 USD 2022) by Moucharite et al, 2021.6
  • To our knowledge, there is no published estimate of cost of esophageal intubation, we assume it to be similar to the cost of tracheal injury published by Bhatti et al. 2010, at about $1,888 (3,192 USD 2022).7

NOTE: the handles sterilization time used in the backend of the calculator has been informed by Dewayne Whitener, 2012.8

Potential for cost savings related to adverse events

When using McGRATH™ MAC VL as the first-line device

Failure to achieve first-pass success costs

Prevented failures to achieve first-pass success

=

$

Failed intubation costs

Prevented failed intubations

=

$

Esophageal intubation costs

Prevented esophageal intubations

=

$

Estimated costs of Macintosh direct laryngoscopy

Acquisition cost of direct laryngoscope handles
$
Running cost for direct laryngoscopy (blades &
reprocessing)
$
Costs related to adverse events
$

Potential to prevent adverse events

When using McGRATH™ MAC VL as the first-line device

Prevented failures to achieve first-pass success
Prevented failed intubations
Prevented esophageal intubation

Total potential savings

$

This estimate is based on published literature and user inputs. Preventing adverse events improves patient outcomes and has the potential to prevent associated costs.

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