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Clements W, Brown N, Koukounaras J. Remembering the Important and Complimentary Place of Both Interventional Radiologists and Hepatobiliary Surgeons in the Hepatocellular Carcinoma (HCC) Multidisciplinary Team. Cardiovasc Intervent Radiol 2024; 47:1021-1022. [PMID: 38755292 DOI: 10.1007/s00270-024-03751-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 05/02/2024] [Indexed: 05/18/2024]
Affiliation(s)
- Warren Clements
- Department of Radiology, Alfred Health, 55 Commercial Road, Melbourne, VIC, 3004, Australia.
- Department of Surgery, Monash University Central Clinical School, Melbourne, Australia.
- National Trauma Research Institute, Melbourne, Australia.
| | - Nicholas Brown
- The University of Queensland, St Lucia, QLD, Australia
- Wesley Hospital, Auchenflower, QLD, Australia
- The Prince Charles Hospital, Chermside, QLD, Australia
| | - Jim Koukounaras
- Department of Radiology, Alfred Health, 55 Commercial Road, Melbourne, VIC, 3004, Australia
- Department of Surgery, Monash University Central Clinical School, Melbourne, Australia
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Clements W, Chenoweth A, Morphett L, Billington E, Nandurkar R, Phan T, Venn GA, Lukies MW. A cost outcome study of varicocoele embolisation and future pregnancy in an Australian public hospital setting. J Med Imaging Radiat Oncol 2024; 68:282-288. [PMID: 38437182 DOI: 10.1111/1754-9485.13629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 02/21/2024] [Indexed: 03/06/2024]
Abstract
INTRODUCTION Varicocoele is commonly encountered in males with infertility. Studies have shown that varicocoele repair (surgery or embolisation) can improve the rate of subsequent pregnancy. In Australia, there have been no studies assessing the cost of varicocoele embolisation and current practice is based on international data. This study aimed to assess the cost of varicocoele embolisation and estimate the treatment cost per pregnancy. METHODS Retrospective cost-outcome study of patients treated by embolisation between January 2018 and 2023. A bottom-up approach was used to calculate procedure costs whereas a top-down approach was used to calculate costs for all other patient services, including direct and indirect costs. To calculate cost per pregnancy, costs were adjusted according to existing published data on the rate of pregnancy after embolisation. RESULTS Costing data from 18 patients were included, of median age 33.5 years (range 26-60) and median varicocoele grade 2.5 (range 1-3). All patients had unilateral treatment, most commonly via right internal jugular (16 patients, 89%) and using a 0.035″ system (17 patients, 94%). The median cost for the entire treatment including procedural, non-procedural, ward and peri-procedural costs was AUD$2208.10 (USD$1405 or EUR€1314), range AUD$1691-7051. The projected cost to the healthcare system per pregnancy was AUD$5387 (USD$3429 or EUR€3207). CONCLUSION Total varicocoele embolisation cost and the cost per-pregnancy were lower than for both embolisation and surgical repair in existing international studies. Patients undergoing varicocoele treatment should have the option to access an interventional radiologist to realise the benefits of this low-cost pinhole procedure.
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Affiliation(s)
- Warren Clements
- Department of Radiology, Alfred Health, Melbourne, Victoria, Australia
- Department of Surgery, Monash University Central Clinical School, Melbourne, Victoria, Australia
- National Trauma Research Institute, Melbourne, Victoria, Australia
| | - Abigail Chenoweth
- Department of Radiology, Alfred Health, Melbourne, Victoria, Australia
| | - Laura Morphett
- Department of Finance, Alfred Health, Melbourne, Victoria, Australia
| | - Eliza Billington
- Department of Radiology, Alfred Health, Melbourne, Victoria, Australia
| | - Rohan Nandurkar
- Department of Radiology, Alfred Health, Melbourne, Victoria, Australia
| | - Tuan Phan
- Department of Radiology, Alfred Health, Melbourne, Victoria, Australia
- Department of Surgery, Monash University Central Clinical School, Melbourne, Victoria, Australia
| | - Georgina A Venn
- Department of Radiology, Alfred Health, Melbourne, Victoria, Australia
| | - Matthew W Lukies
- Department of Radiology, Alfred Health, Melbourne, Victoria, Australia
- Department of Medical Imaging, Monash Health, Melbourne, Victoria, Australia
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Brown N. Reimbursement of interventional oncology in Australia: How it works and how it does not. J Med Imaging Radiat Oncol 2023; 67:915-925. [PMID: 38105584 DOI: 10.1111/1754-9485.13608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 11/09/2023] [Indexed: 12/19/2023]
Abstract
The practice of interventional oncology (IO) embodies all the qualities that one would expect to find in a modern, value-based healthcare system. A dynamic, cutting-edge specialty like IO uses highly-targeted, minimally-invasive, image-guided techniques to deliver cost-effective, personalised medicine for cancer patients. Unfortunately, the technical and clinical sophistication of IO is not matched by the reimbursement models and funding arrangements in Australia to fully support this critical component of patient care. Differences between state and federal funding lead to inequity of access to 'standard of care' interventions for patients across public and private hospitals. IO procedures are poorly represented in the Medicare Benefits Schedule and often inadequately funded to cover the true costs of providing care. Complex private health fund reimbursements and inconsistent rebates for prostheses and essential equipment result in inconsistent access to important services and widely variable out-of-pocket costs for patients. IO techniques must be supported by fair, consistent and equitable funding arrangements at all levels to allow for integrated contemporary patient care; only then will the full clinical and economic benefits of IO be realised.
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Affiliation(s)
- Nicholas Brown
- The Wesley Hospital, Brisbane, Queensland, Australia
- The University of Queensland, School of Medicine, Brisbane, Queensland, Australia
- The Prince Charles' Hospital, Brisbane, Queensland, Australia
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Clements W, So J, Koukounaras J, Lau G, Lukies MW. Research output of radiologists in Australia and New Zealand: Strengths, weaknesses and future directions. J Med Imaging Radiat Oncol 2023; 67:697-702. [PMID: 37302986 DOI: 10.1111/1754-9485.13548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 06/03/2023] [Indexed: 06/13/2023]
Abstract
INTRODUCTION Clinical radiology is a popular career. However, academic radiology in Australia and New Zealand (ANZ) has not traditionally been a strength of the specialty which has a focus on clinical medicine and has been influenced by corporatisation of the specialty. The aim of this study was to review the source(s) of radiologist-led research in Australia and New Zealand, to identify areas of relative deficiency and propose plans to improve research output. METHODS A manual search was performed of all manuscripts in seven popular ANZ journals, where the corresponding or senior author was a radiologist. Publications between January 2017 and April 2022 were included. RESULTS There were 285 manuscripts from ANZ radiologists during the study period. This equates to 10.7 manuscripts per 100 radiologists based on RANZCR census data. Radiologists in Northern Territory, Victoria, Western Australia, South Australia and the Australian Capital Territory all produced manuscripts above the corrected mean incidence rate of 10.7 manuscripts per 100 radiologists. However, locations including Tasmania, New South Wales, New Zealand and Queensland were below the mean. The majority of manuscripts arose from public teaching hospitals with accredited trainees (86%), and there were a higher proportion of manuscripts published by female radiologists (11.5 compared to 10.4 per 100 radiologists). CONCLUSION Radiologists in ANZ are academically active; however, interventions aimed at increasing output could be targeted at certain locations and/or areas within a busy private sector. Time, culture, infrastructure and research support are vital, but personal motivation is also extremely important.
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Affiliation(s)
- Warren Clements
- Department of Radiology, Alfred Health, Melbourne, Victoria, Australia
- Department of Surgery, Monash University, Melbourne, Victoria, Australia
- National Trauma Research Institute, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Joanne So
- Department of Radiology, Alfred Health, Melbourne, Victoria, Australia
| | - Jim Koukounaras
- Department of Radiology, Alfred Health, Melbourne, Victoria, Australia
- Department of Surgery, Monash University, Melbourne, Victoria, Australia
| | - Gabes Lau
- Radiology Department, Dunedin Public Hospital, Dunedin, New Zealand
| | - Matthew W Lukies
- Department of Radiology, Alfred Health, Melbourne, Victoria, Australia
- Department of Diagnostic and Interventional Imaging, KK Women's and Children's Hospital, Singapore City, Singapore
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Clements W, Lukies MW. Management of Spontaneous Retroperitoneal Haemorrhage Emphasises the Need for Nuanced Clinical Decision Making in Interventional Radiology. Cardiovasc Intervent Radiol 2023; 46:701-702. [PMID: 37043077 DOI: 10.1007/s00270-023-03431-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 03/24/2023] [Indexed: 04/13/2023]
Affiliation(s)
- Warren Clements
- Department of Radiology, Alfred Health, 55 Commercial Road, Melbourne, VIC, 3004, Australia.
- Department of Surgery, Central Clinical School, Monash University, Melbourne, Australia.
- National Trauma Research Institute, Central Clinical School, Monash University, Melbourne, Australia.
| | - Matthew W Lukies
- Department of Radiology, Alfred Health, 55 Commercial Road, Melbourne, VIC, 3004, Australia
- Department of Diagnostic and Interventional Imaging, KK Women's and Children's Hospital, Singapore, Singapore
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Reply to "Damage Control Interventional Radiology (DCIR): Evolving Value of Interventional Radiology in Trauma". Cardiovasc Intervent Radiol 2022; 45:1759-1761. [PMID: 36151338 DOI: 10.1007/s00270-022-03275-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 08/29/2022] [Indexed: 11/02/2022]
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