Cost Minimization and Cost Comparison of the Use of Conventional Double Lumen Tube versus Single-Use VivaSight-Double Lumen Tube in Thoracic Surgery: The Pascale Institute Experience

Maurizio Marchesini,1 Michela D’Antò,2 Rosanna Accardo,1 Marika Aprea,3 Giuseppe D’Agostino,2 Maria Romano,4 Vittorio Santoriello,4 Gilda Pasta,1 Francesca Bifulco,1 Arturo Cuomo1 1UTI/ICU Department, IRCCS Fondazione G. Pascale, Napoli, Italy; 2Clinical Engineering Department, IRCCS Fondazione G. Pascale, Napoli, Italy; 3UTI/ICU Department, Azienda Ospedaliera San Camillo Forlanini, Roma, Italy; 4Faculty of Clinical Engineering, Università Degli Studi Di Napoli Federico II, Napoli, ItalyCorrespondence: Giuseppe D’Agostino, Clinical Engineering Department, IRCCS Fondazione G. Pascale, Napoli, Italy, Email [email protected]: One lung ventilation (OLV) is essential in thoracic surgery to isolate and ventilate a single lung, ensuring optimal surgical exposure and patient safety. Precise placement of a double lumen tube (DLT) is critical and conventionally confirmed via reusable bronchoscopy.Patients and Methods: We evaluated the economic and organisational impact of introducing VivaSightDLT—an endobronchial tube with an integrated camera—at Fondazione G. Pascale (Naples). Data from 50 patients were reviewed to compare device efficacy and positioning accuracy. Cost data from the Institute’s management control informed a cost minimization analysis (CMA) and cost comparison analysis (CCA), projecting financial outcomes over 1, 3, and 5 years, based on an annual thoracic surgery volume of 400 cases (328 eligible for VivaSightDLT).Results: Although the per unit cost of VivaSightDLT exceeds that of the conventional DLT, mean savings per procedure were € 86.36. When additional intraoperative bronchoscopic checks were required, savings increased to € 193.89 per case. Net savings of € 16,728.54 at 1 year, € 50,185.62 at 3 years, and € 83,642.70 at 5 years (15% reduction in direct variable costs) were projected. Full replacement of conventional DLTs would yield a 41% reduction in direct variable costs (€ 33,457.08, € 100,371.25, and € 167,285.41 over 1, 3, and 5 years, respectively). VivaSightDLT also reduced operative times by 14– 25 minutes (19.5 min IC95%: 14– 25), enhancing operating room turnover.Conclusion: The integration of VivaSight DLT at the Istituto Nazionale Tumori, Fondazione G. Pascale, demonstrates superior cost-effectiveness and procedural organisational efficiency compared to conventional DLTs. By eliminating routine reusable bronchoscopy and reducing procedure duration, VivaSight DLT represents an optimal strategy for OLV in thoracic surgery.Keywords: intubation, one-lung ventilation, cost evaluation, thoracic surgery