Costs of medical investigations (CT, MRI etc)

chanste

Hi all,

I am doing a project for my 3rd year in med school and I was wondering would anybody know a good way to approach costing analysis in this type of thing? I would ideally like to say something like "If we could reduce the number of CT scans per month by X, it would lead to a saving to the HSE of Y"

I'm just giving an example with CT scans, but I would also be interested in finding the costs to the HSE of various investigations whether it be an MRI scan or a FBC, TFT etc. People in the hospital seem vaguely aware of what's expensive and what isn't but to be able to quote some numbers it would be great.

Thanks

eilo1

Hiya,

I couldnt tell you what the cost is the HSE but you could get a rough idea from the euromedic website. They are the private group that give mri's and dexa scans etc from various clinics in Ireland. All the costs are on their website.

chanste

eilo1 wrote: »

Hiya,

I couldnt tell you what the cost is the HSE but you could get a rough idea from the euromedic website. They are the private group that give mri's and dexa scans etc from various clinics in Ireland. All the costs are on their website.

Thanks for that. Should come in useful. Would still be grateful if other people can tell me if they have done something similar.

lonestargirl

The problem is that it's mostly capital costs to buy a CT or MRI and then just ongoing staffing costs. If it's only used sporadically then the cost per scan actually increases. In my experience CT use is quite tightly controlled already in most hospitals.

chanste

lonestargirl wrote: »

The problem is that it's mostly capital costs to buy a CT or MRI and then just ongoing staffing costs. If it's only used sporadically then the cost per scan actually increases. In my experience CT use is quite tightly controlled already in most hospitals.

I was thinking about this, and what your saying makes perfect sense, but reading some journals has given me the impression that it is still a good thing if they can reduce the usage of them, so I figured there must be some convoluted way that a value is assigned to each scan.

The way I figure it could work is that if they think the lifetime of the machine and associated staff costs will benefit 1000 patients it may be worth it, but if it only benefits 8000 patients it might not and something else could be bought instead.

I'm thinking that for my project I may just put a note in about the costs to get it done privately if I can't find anything more firm about HSE costs.

Alun

There are some not inconsiderable ongoing operational costs too though. There will always be an ongoing maintenance contract with the manufacturer, and maintenance intervals will probably be decided by the number of uses. Plus there's a good amount of electricity required to power those superconducting magnets, and there's also the cost of the cryogenic cooling, i.e. liquid helium which may well be a problem in the future seeing as supplies of it are 'running out' despite it being the most abundant element in the solar system.

smk89

If your ever in hospital in my experience the best port of call are the nurses. Once I got a 10 minute explanation of the costs of various items. It really opens your eyes.

lonestargirl

@Alun
QA and maintenace is usually on a time schedule rather than 'per use'. Elements are divided up into things that are checked daily, weekly, monthly, annually etc.

There is some info out there for the NHS.

Audit report on their high value equipment.

A whole journal dedicated to resource allocation and cost effectiveness.

Of course with any radiology you also have to include the cost of the doctor to read the scan.

Alun

lonestargirl wrote: »

@Alun
QA and maintenace is usually on a time schedule rather than 'per use'. Elements are divided up into things that are checked daily, weekly, monthly, annually etc.

I'm surprised at that ... there are lots of mechanical components in both CT and MRI scanners and these would to my mind require more frequent maintenance the more they are used, much the same as a car would for example.

opinion guy

Hmmm when there are waiting lists stretching back for weeks and months (if you are public) for scans that people need I'm not sure I agree with your sentiment of 'cut the number of scans to save money'.

What, to add balance, you might look at also at the same time are the following:
a) the cost to the HSE of delaying scans incurred by later treatment of treatable conditions
b) the number of scans that are ordered inappropriately

If someone needs a scan they need it - and usually the sooner the better - delaying them may incur costs, so its only the inappropriate scans you would want to cut. Apply the same logic to fbc's etc etc

chanste

opinion guy wrote: »

Hmmm when there are waiting lists stretching back for weeks and months (if you are public) for scans that people need I'm not sure I agree with your sentiment of 'cut the number of scans to save money'.

What, to add balance, you might look at also at the same time are the following:
a) the cost to the HSE of delaying scans incurred by later treatment of treatable conditions
b) the number of scans that are ordered inappropriately

If someone needs a scan they need it - and usually the sooner the better - delaying them may incur costs, so its only the inappropriate scans you would want to cut. Apply the same logic to fbc's etc etc

Well I didn't really want to get into the details of my project because details haven't entirely been settled upon, but when I refer to reducing the number of scans or investigations, I don't mean by just cutting the number, which as far as I know wouldn't require much research at all, rather just a harder line on expenditure.

I was planning on examining how investigations ordered in various groups of people of different, ages, sexes, co-morbidities etc related to investigations from an outcome perspective. Have excessive TFTs (or whatever investigation) been ordered in a group which never turns a result which will effect treatment. If I could find such a group for any investigations I would say there is a case to be made for discontinuing tests in people matching their criteria (naturally taking into account risks of serious consequences).