1
|
Baskar D, Jarmul JA, Donnelly LF. Expenditure mapping of pediatric imaging costs using a resource utilization band analysis of claims data. Curr Probl Diagn Radiol 2024:S0363-0188(24)00129-4. [PMID: 39048500 DOI: 10.1067/j.cpradiol.2024.07.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2024] [Accepted: 07/17/2024] [Indexed: 07/27/2024]
Abstract
OBJECTIVE To segregate imaging expenditures from claims data by resource utilization bands (RUBs) and underlying conditions to create an "expenditure map" of pediatric imaging costs. METHODS A Claims data for children enrolled in a commercial value-based plan were categorized by RUB 0 non-user, 1 healthy user, 2 low morbidity, 3 moderate morbidity, 4 high morbidity, & 5 very high morbidity. The per member per year (PMPY) expense, total imaging spend, and imaging modality with the highest spend were assessed for each RUB. Diagnosis categories associated with high imaging costs were also evaluated. RESULTS There were 40,022 pediatric plan members. 14% had imaging-related claims accounting for approximately $2.8 million in expenditures. Member distribution and mean PMPY expenditure RUB was respectively: RUB 0 (3,037, $0), RUB 1 (6,604, $7), RUB 2 - 13,698, $27), RUB 3 - 13,341, $87), RUB 4 (2,810, $268), RUB 5 (532, $841). RUB 3 had the largest total imaging costs at $1,159,523. The imaging modality with the greatest mean PMPY expense varied by RUB with radiography highest in lower RUBs and MRI highest in higher RUBs. The top 3 diagnoses associated with the highest total imaging costs were developmental disorders ($443,980), asthma ($388,797), and congenital heart disease ($294,977) and greatest mean PMPY imaging expenditures malignancy/leukemia ($3,100), transplant ($2,639), and tracheostomy ($1,661). DISCUSSION Expense mapping using claims data allows for a better understanding of the distribution of imaging costs across a covered pediatric population. This tool may assist organizations in planning effective cost-reduction initiatives and learning how imaging utilization varies by patient complexity in their system.
Collapse
Affiliation(s)
- Danika Baskar
- Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Jamie A Jarmul
- University of North Carolina Health Alliance, Morrisville, NC, USA
| | - Lane F Donnelly
- Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, NC, USA; Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC, USA; University of North Carolina Health Alliance, Morrisville, NC, USA.
| |
Collapse
|
2
|
Waller J, DeStefano K, Dempsey J, Leckron J, Tucker A, Umair M. A Primer to Cost-Effectiveness Analysis in Breast Cancer Imaging: A Review of the Literature. Cureus 2022; 14:e28356. [PMID: 36106225 PMCID: PMC9457393 DOI: 10.7759/cureus.28356] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/23/2022] [Indexed: 11/11/2022] Open
Abstract
Currently, there is a multitude of methods for evaluating the costs and benefits of programs, tools, etc. While cost-benefit analysis (CBA) is commonly used, cost-effectiveness analysis (CEA) is a more appropriate method of evaluation in clinical contexts, such as radiology practices, as CEAs use units such as life years gained as opposed to money (as is the case for CBAs). This review examines CEAs performed within the past 15 years to highlight their applications and key findings in the context of medical imaging. In total, 20 articles published between 2006 and 2022 were identified using a PubMed search for keywords including “cost-effectiveness analysis,” “breast cancer,” and “medical imaging,” with studies lacking a substantial discussion of CEA or a related topic being excluded. CEAs have traditionally been criticized for lack of a standard methodology, despite their utility in the detection and treatment of various pathologies. Although mammography and magnetic resonance imaging (MRI) are the preferred and cost-effective imaging modalities for breast cancer, other imaging modalities, such as contrast-enhanced mammography and digital breast tomosynthesis, may be more cost-effective in the appropriate clinical context. Different combinations of mammography and MRI screenings for certain breast cancers may also prove to be more cost-effective compared to current mammography/MRI screening schedules. While CEA has shown potential utility in estimating the costs (per unit of health gained) of different imaging tools, CEA risks ignoring important outcomes not included in the analysis and cannot address if the benefits of the imaging tool exceed its costs, as a CBA would, suggesting the need for combining several economic evaluations for a more complete understanding.
Collapse
|
3
|
Daggett SM, Cantarelli T, Gyftopoulos S, Krueger P, Ross AB. Cost-effectiveness Analysis in Diagnostic Musculoskeletal Radiology: A Systematic Review. Curr Probl Diagn Radiol 2022; 52:20-24. [DOI: 10.1067/j.cpradiol.2022.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 07/27/2022] [Indexed: 11/22/2022]
|
4
|
Feletti F, Mellini L, Pironi F, Carnevale A, Parenti GC. Role of the cytopathologist during the procedure of fine-needle aspiration biopsy of thyroid nodules. Insights Imaging 2021; 12:111. [PMID: 34370089 PMCID: PMC8350303 DOI: 10.1186/s13244-021-01053-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 07/05/2021] [Indexed: 01/30/2023] Open
Abstract
Purpose This study aimed to conduct a diagnostic and cost-effective analysis of the cytopathology assistance in the ultrasound (US)-guided fine-needle aspiration biopsy (FNAB) for characterising thyroid nodules. Materials and methods We reviewed the reports relative to 9061 US-guided FNABs for the histologic definition of the nature of thyroid nodules: 45.4% completed with the cytopathologist assistance and 54.6% by the radiologist alone. We also performed the cost-effectiveness analysis (CEA) of the procedure with and without the cytopathologist assistance. Results We found a significant positive correlation between the adoption/non-adoption of cytopathologist assistance and the number of indeterminate (TIR1) (Chi-square; z-score, Z = 10.22; critical value 5%, C = 1.96; p < 0.001). The cytopathologist's absence was correlated with the number of TIR 1 (Pearson correlation, product–moment correlation r = 0.059; critical value 5%, C = 0.008; p < 0.001). The total cost of the model's cytopathologist-assistance branch is 109.87€, while the total cost of the non-cytopathologist-assistance branch is 95.08€. Conclusion The cytopathologist assistance resulted in fewer nondiagnostic results, thus excluding the procedure's repetition but involved a higher expense, mainly due to the professional cost of the pathologist's participation. These data may provide decision-makers in healthcare with a practical evidence based on the opportunity to include the cytopathologist assistance in the thyroid nodule's FNAB depending on the available resources and the population's expectance. Supplementary information The online version contains supplementary material available at 10.1186/s13244-021-01053-y.
Collapse
Affiliation(s)
- F Feletti
- Department of Diagnostic Imaging Ausl Romagna, Unit of Radiology, S. Maria Delle Croci Hospital, Viale Randi 5, Ravenna, Italy.
| | - L Mellini
- Department of Diagnostic Imaging Ausl Romagna, Unit of Radiology, S. Maria Delle Croci Hospital, Viale Randi 5, Ravenna, Italy
| | - F Pironi
- DAMeTLab, Unit of Anatomical Pathology, S. M. Delle Croci Hospital, Ravenna, Italy
| | - A Carnevale
- Department of Radiology, University Radiology Unit, Sant'Anna University Hospital, Ferrara, Italy
| | - G C Parenti
- Department of Diagnostic Imaging Ausl Romagna, Unit of Radiology, S. Maria Delle Croci Hospital, Viale Randi 5, Ravenna, Italy
| |
Collapse
|
5
|
Lentz B, Fong T, Rhyne R, Risko N. A systematic review of the cost-effectiveness of ultrasound in emergency care settings. Ultrasound J 2021; 13:16. [PMID: 33687607 PMCID: PMC7943664 DOI: 10.1186/s13089-021-00216-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 02/19/2021] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND The use of ultrasound (US) in emergency departments (ED) has become widespread. This includes both traditional US scans performed by radiology departments as well as point-of-care US (POCUS) performed by bedside clinicians. There has been significant interest in better understanding the appropriate use of imaging and where opportunities to enhance cost-effectiveness may exist. The purpose of this systematic review is to identify published evidence surrounding the cost-effectiveness of US in the ED and to grade the quality of that evidence. METHODS We performed a systematic review of the literature following Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines. Studies were considered for inclusion if they were: (1) economic evaluations, (2) studied the clinical use of ultrasound, and (3) took place in an emergency care setting. Included studies were critically appraised using the Consolidated Health Economic Evaluation Reporting Standards checklist. RESULTS We identified 631 potentially relevant articles. Of these, 35 studies met all inclusion criteria and were eligible for data abstraction. In general, studies were supportive of the use of US. In particular, 11 studies formed a strong consensus that US enhanced cost-effectiveness in the investigation of pediatric appendicitis and 6 studies supported enhancements in the evaluation of abdominal trauma. Across the studies, weaknesses in methodology and reporting were common, such as lack of sensitivity analyses and inconsistent reporting of incremental cost-effectiveness ratios. CONCLUSIONS The body of existing evidence, though limited, generally demonstrates that the inclusion of US in emergency care settings allows for more cost-effective care. The most definitive evidence for improvements in cost-effectiveness surround the evaluation of pediatric appendicitis, followed by the evaluation of abdominal trauma. POCUS outside of trauma has had mixed results.
Collapse
Affiliation(s)
- Brian Lentz
- Department of Emergency Medicine, Highland Hospital-Alameda Health System, 1411 E. 31st Street, QIC 22123, Oakland, CA, 94602, USA
| | - Tiffany Fong
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, 1800 Orleans St, Baltimore, MD, 21287, USA
| | - Randall Rhyne
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, 1800 Orleans St, Baltimore, MD, 21287, USA
| | - Nicholas Risko
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, 1800 Orleans St, Baltimore, MD, 21287, USA.
| |
Collapse
|
6
|
Maudgil DD. Cost effectiveness and the role of the National Institute of Health and Care Excellence (NICE) in interventional radiology. Clin Radiol 2020; 76:185-192. [PMID: 33081990 PMCID: PMC7568486 DOI: 10.1016/j.crad.2020.09.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 09/16/2020] [Indexed: 12/12/2022]
Abstract
Healthcare expenditure is continually increasing and projected to accelerate in the future, with an increasing proportion being spent on interventional radiology. The role of cost effectiveness studies in ensuring the best allocation of resources is discussed, and the role of National Institute of Health and Care Excellence (NICE) in determining this. Issues with demonstrating cost effectiveness have been discussed, and it has been found that there is significant scope for improving cost effectiveness, with suggestions made for how this can be achieved. In this way, more patients can benefit from better treatment given limited healthcare budgets.
Collapse
Affiliation(s)
- D D Maudgil
- Radiology Department, Wexham Park Hospital, Frimley Health Foundation Trust, Wexham Street, Slough, Berks, SL2 4HL, UK.
| |
Collapse
|
7
|
Yousem DM, Zhou A, Alvin MD. CT Angiography for Triage of Minor Stroke: Controversial Analysis. Radiology 2020; 296:E124-E125. [DOI: 10.1148/radiol.2020200755] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- David M. Yousem
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 600 N Wolfe St, Phipps Basement B112D, Baltimore MD 21287
| | - Alice Zhou
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 600 N Wolfe St, Phipps Basement B112D, Baltimore MD 21287
| | - Matthew D. Alvin
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 600 N Wolfe St, Phipps Basement B112D, Baltimore MD 21287
| |
Collapse
|
8
|
Hayatghaibi SE, Chau A, Wadler EG, Levine MH, Hernandez AJ, Orth RC. Cost Comparison of In-Suite Versus Portable Tunneled Femoral Central Line Placements in Children Using Time-Driven Activity-Based Costing. J Am Coll Radiol 2020; 17:462-468. [DOI: 10.1016/j.jacr.2019.11.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 10/17/2019] [Accepted: 11/04/2019] [Indexed: 11/30/2022]
|
9
|
Otero HJ, Degnan AJ, Kadom N, Neumann PJ, Lavelle TA. Cost-Effectiveness Analysis in Pediatric Imaging: The Evidence (or Lack Thereof) Thus Far. J Am Coll Radiol 2019; 17:452-461. [PMID: 31790678 DOI: 10.1016/j.jacr.2019.10.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Revised: 10/07/2019] [Accepted: 10/07/2019] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To systematically review all published cost-effectiveness analyses (CEAs) of imaging technologies in children. METHODS We identified all CEAs involving fetal and pediatric imaging included in a publicly available repository of CEAs published since 1976. Information on publication characteristics, methods, costs, quality of life weights, and incremental cost-effectiveness ratios (ICERs) was recorded for each article. RESULTS Of 480 diagnostic CEAs, only 10 focused on fetal and pediatric imaging. The 10 studies reported 43 quality of life weights based on previously published adult data (n = 20, 46.5%); pregnant women perspective (n = 11, 25.6%), and treating physician perspective (n = 12, 27.9%). None of the studies elicited quality of life weights from children nor took into consideration the postnatal impact of disease on family's quality of life. All studies used a health care payer perspective without incorporating patients' incurred cost such as loss wages or travel related cost. Of 37 ICERs, 7 (18.9%) were cost saving and 6 (16.2%) were more expensive and less effective. The remaining ICERs ranged from $1,400 per quality-adjusted life-year (MRI versus ultrasound in newborns with moderate risk of occult spinal dysraphism) to $10,000,000 per quality-adjusted life-year (CT versus no imaging in children at low risk for craniosynostosis). CONCLUSION There is a striking paucity of cost-effectiveness studies evaluating imaging technologies in children. Existing studies do not incorporate the patient and family perspectives regarding utilities (eg, impact of child's disease on families' quality of life) or cost (eg, loss wages, travel, time off). Future studies should elicit and incorporate the impact of disease on families to better reflect real-world scenarios.
Collapse
Affiliation(s)
- Hansel J Otero
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
| | - Andrew J Degnan
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Nadja Kadom
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia; Department of Radiology, Children's Healthcare of Atlanta (Egleston), Atlanta, Georgia
| | - Peter J Neumann
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts
| | - Tara A Lavelle
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts
| |
Collapse
|
10
|
Kim JW, Lee CH, Park YS, Lee J, Kim KA. Abbreviated Gadoxetic Acid-enhanced MRI with Second-Shot Arterial Phase Imaging for Liver Metastasis Evaluation. Radiol Imaging Cancer 2019; 1:e190006. [PMID: 33778670 PMCID: PMC7983790 DOI: 10.1148/rycan.2019190006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 04/16/2019] [Accepted: 04/23/2019] [Indexed: 05/15/2023]
Abstract
PURPOSE To evaluate the feasibility of an abbreviated gadoxetic acid-enhanced MRI protocol including second-shot arterial phase (SSAP) imaging for liver metastasis evaluation. MATERIALS AND METHODS For this retrospective study, a total of 197 patients with cancer (117 men and 80 women; mean age, 62.9 years) were included who underwent gadoxetic acid-enhanced MRI performed by using a modified injection protocol for liver metastasis evaluation from July to August 2017. The modified injection protocol included routine dynamic imaging after a first injection of 6 mL and SSAP imaging after a second injection of 4 mL. Image set 1 was obtained with the full original protocol. Image set 2 consisted of T2-weighted, diffusion-weighted, hepatobiliary phase, and SSAP images (the simulated abbreviated protocol). Acquisition time was measured in each image set. The diagnostic performance of each image set was compared by using a jackknife alternative free-response receiver operating characteristic analysis. Image quality evaluation and visual assessment of vascularity were performed on the original arterial phase images, the SSAP images, and their subtraction images. RESULTS The acquisition time was significantly shorter in image set 2 than in image set 1 (18.6 vs 6.2 minutes, P <.0001). The reader-averaged figure-of-merit was not significantly different between image sets 1 and 2 (P = .197). The mean motion artifact score was significantly lower for the SSAP images than for the original arterial phase images (P <.001). All hypervascular metastases (n = 72) showed hyperintensity on the SSAP and/or the second subtraction images. CONCLUSION An abbreviated MRI protocol including SSAP is feasible for liver metastasis evaluation, providing faster image acquisition while preserving diagnostic performance, image quality, and visual vascularity.Keywords: Abdomen/GI, Comparative Studies, Liver, MR-Imaging, Metastases© RSNA, 2019Supplemental material is available for this article.
Collapse
|