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Narvaez JA, Bernabeu D, Muntaner L, Gomez F, Martel J, Castellano MDM, García-Marcos R, Britel R, Oyagüez I, Tejado N, Ortiz-Cruz E. Economic evaluation of percutaneous cryoablation vs conventional surgery in extra-abdominal desmoid tumours in the Spanish healthcare system. Insights Imaging 2024; 15:1. [PMID: 38185710 PMCID: PMC10772037 DOI: 10.1186/s13244-023-01580-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 11/25/2023] [Indexed: 01/09/2024] Open
Abstract
BACKGROUND Desmoid tumours (DTs) or deep fibromatosis are benign soft-tissue tumours, sometimes locally aggressive, requiring intervention on some cases. Surgery has been the gold standard, but new less invasive techniques such as percutaneous cryoablation have proved their effectiveness, reducing health resources and complications. The study aimed to compare the total cost of percutaneous cryoablation and conventional surgery for patients with extra-abdominal and/or abdominal wall DTs, candidates for local ablative treatment in Spain. METHODS A cost-analysis model was developed. An expert panel provided data about resource consumption for the percutaneous cryoablation technique and validated the epidemiology used for target population estimation. Unitary resources cost (€ 2022) derived from local cost databases. A retrospective analysis of 54 surgical cases in 3 Spanish hospitals was performed to estimate the cost of conventional surgery based on the cost of the Diagnosis-Related group (DRG) codes identified on this patient sample, weighted by each DRG proportion. The total cost for each alternative included intervention cost and complications cost, considering debridement required in 4.5% of cases with percutaneous cryoablation and minor surgery for surgical site infection in 18.0% for conventional surgery. RESULTS The total cost for percutaneous cryoablation (€ 5774.78/patient-year) was lower than the total cost for conventional surgery (€ 6780.98/patient-year), yielding cost savings up to € 80,002 in 1 year for the entire cohort of 80 patients with DTs eligible for intervention estimated in Spain. One-way sensitivity analyses confirmed the results' robustness. CONCLUSION Percutaneous cryoablation versus conventional surgery would yield cost savings for the management of DT patients in Spain. CRITICAL RELEVANCE STATEMENT This manuscript provides insight into the economic impact derived from the savings related to the use of percutaneous cryoablation for desmoid-type tumours from the perspective of the Spanish National Healthcare System, providing useful information for the health decision-making process. KEY POINTS • Desmoid tumours are locally aggressive and may require local therapy. • Percutaneous cryoablation procedure is less invasive than the conventional surgery. • Cost comparison shows savings associated to percutaneous cryoablation use.
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Affiliation(s)
- José Antonio Narvaez
- Musculoskeletal Radiology, Hospital Universitario de Bellvitge-IDIBELL, Barcelona, Spain
- Faculty of Medicine and Health Sciences, Universitat de Barcelona, Barcelona, Spain
| | - Daniel Bernabeu
- Musculoskeletal Radiology, Hospital Universitario La Paz, Madrid, Spain
| | - Lorenzo Muntaner
- Hospital Son Espases, Radiología Intervencionista, Mallorca, Spain
| | - Fernando Gomez
- Hospital Sant Joan de Deu, Radiología Intervencionista, Barcelona, Spain
| | - José Martel
- Departamento de Radiología Musculoesqueletica, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | | | - Raúl García-Marcos
- , Radiología Intervencionista, Hospital Universitario La Fe, Valencia, Spain
| | - Reda Britel
- Hospital Son Espases, Radiología Intervencionista, Mallorca, Spain
| | - Itziar Oyagüez
- Pharmacoeconomics & Outcomes Research Iberia (PORIB), Madrid, Spain.
| | - Nerea Tejado
- Pharmacoeconomics & Outcomes Research Iberia (PORIB), Madrid, Spain
| | - Eduardo Ortiz-Cruz
- Cirugía Ortopédica Oncológica, Hospital Universitario La Paz, Madrid, Spain
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Matsumoto AH, Dake MD. Implications of IR Being a Primary Specialty on the Professional Organizational Relationship between Interventional and Diagnostic Radiology. J Vasc Interv Radiol 2023; 34:2080-2084. [PMID: 38008543 DOI: 10.1016/j.jvir.2023.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 08/12/2023] [Indexed: 11/28/2023] Open
Abstract
The recent awarding of primary specialty status to interventional radiology (IR) invites a re-examination of the long-standing relationship between IR and diagnostic radiology (DR). In this new era, it is important to evaluate how the organizations that represent these 2 specialties can best contribute to strengthening a growth in collaborations and partnerships that will benefit their members and patients. Areas of organizational focus with the potential to enhance the future for both groups include combining efforts directed toward advocacy and government relations, developing practice models to create successful IR and DR working relationships, and providing more data to demonstrate the value of IR above and beyond the work relative value units and professional revenues that IR generates.
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Affiliation(s)
- Alan H Matsumoto
- Department of Radiology and Medical Imaging, University of Virginia Health, Charlottesville, Virginia.
| | - Michael D Dake
- Department of Medical Imaging, Surgery and Medicine, University of Arizona Health Sciences, Tucson Campus, Health Sciences Innovation Building, Tucson, Arizona
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Marchak K, Malavia M, Trivedi PS. Health Services Research: A Review for the Interventional Radiologist. Semin Intervent Radiol 2023; 40:452-460. [PMID: 37927518 PMCID: PMC10622239 DOI: 10.1055/s-0043-1775849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Abstract
Health services research (HSR) is a multidisciplinary field which studies access to drivers of health care service utilization, the quality and cost of services, and their outcomes on groups of patients. Since its foundations in the 1960s, there has been a large focus on HSR and using large data sets to study real-world care. Because interventional radiology (IR) is a dynamic field with foundations in innovation, research often focuses on small-scale projects. This review will discuss HSR including data sources, focus areas, methodologies, limitations, and opportunities for future directions in IR.
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Affiliation(s)
- Katherine Marchak
- Division of Interventional Radiology, Department of Radiology, University of Colorado, Anschutz Medical Campus, Aurora, Colorado
| | - Mira Malavia
- University of Missouri, Kansas City School of Medicine, Kansas City, Missouri
| | - Premal S. Trivedi
- Division of Interventional Radiology, Department of Radiology, University of Colorado, Anschutz Medical Campus, Aurora, Colorado
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Heft ME, Wong K, James CA, Lewis PS, Hicks ED, Jensen HK, Liu DS, Kaukis NA, Shashi KK, Ashton DJ. Establishing a pediatric interventional radiology inpatient consult service. Pediatr Radiol 2023; 53:1951-1960. [PMID: 37150788 PMCID: PMC10164614 DOI: 10.1007/s00247-023-05664-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 03/29/2023] [Accepted: 04/04/2023] [Indexed: 05/09/2023]
Abstract
OBJECTIVE To delineate pediatric interventional radiology (IR) inpatient consult growth and resulting collections after implementation of a pediatric IR consult service. METHODS An inpatient IR consult process was created at a single academic children's hospital in October 2019. IR consult note templates were created in Epic (Epic Systems Corporation, Verona, Wisconsin) and utilized by 4 IR physicians. Automatic charge generation was linked to differing levels of evaluation and management (E&M) service relating to current procedural terminology (CPT) inpatient consult codes 99251-99255. The children's hospital informatics division identified IR consult notes entered from the implementation of the consult service: October 2019 to January 2022. The university radiology department billing office provided IR service E&M charge, payment, and relative value units (RVU) information during this study period. A chart review was performed to determine the IR procedure conversion rate. Mann-Whitney and a two-sample t-test statistical analyses compared use of the 25-modifier, monthly consult growth and monthly payment growth. P-value < 0.05 was considered statistically significant. RESULTS: Within this 27-month period, a total of 2153 inpatient IR consults were performed during 1757 Epic hospital encounters; monthly consult peak was reached 5 months into the study period. Consult level breakdown by CPT codes: 99251-8.7%, 99252-81.7%, and 99253-8.8%. 69.7% of IR consults had consult-specific billing with payments in 96.4% resulting in $143,976 new revenue. From 2020 to 2021, IR consult volume trended upward by 13.4% (P =0.069), and consult-specific payments increased by 84.1% (P<0.001). IR consult procedure conversion rate was 96.5%. CONCLUSION An inpatient pediatric IR consult service was quickly established and maintained by four physicians over a 27-month study period. Annual IR consult volume trended upward and consult-specific payments increased, resulting in previously uncaptured IR service revenue.
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Affiliation(s)
- Mallory E Heft
- College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Kevin Wong
- Department of Radiology, Arkansas Children's Hospital and University of Arkansas for Medical Sciences, Slot 105, 1 Children's Way, Little Rock, AR, 72202, USA
| | - Charles A James
- Department of Radiology, Arkansas Children's Hospital and University of Arkansas for Medical Sciences, Slot 105, 1 Children's Way, Little Rock, AR, 72202, USA.
| | - P Spencer Lewis
- Department of Radiology, Arkansas Children's Hospital and University of Arkansas for Medical Sciences, Slot 105, 1 Children's Way, Little Rock, AR, 72202, USA
| | - Evan D Hicks
- College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Hanna K Jensen
- Department of Radiology, Arkansas Children's Hospital and University of Arkansas for Medical Sciences, Slot 105, 1 Children's Way, Little Rock, AR, 72202, USA
| | - Daniel S Liu
- Department of Pediatrics and Biomedical Informatics, Arkansas Children's Hospital and University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Nicholas A Kaukis
- Department of Biostatistics, University of Arkansas for Medical Sciences, College of Public Health, Little Rock, AR, USA
| | - Kumar K Shashi
- Department of Radiology, Arkansas Children's Hospital and University of Arkansas for Medical Sciences, Slot 105, 1 Children's Way, Little Rock, AR, 72202, USA
| | - Daniel J Ashton
- Department of Radiology, Arkansas Children's Hospital and University of Arkansas for Medical Sciences, Slot 105, 1 Children's Way, Little Rock, AR, 72202, USA
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Hayirli TC, Warinner CB. Hospital Characteristics Associated with the Availability of Interventional Radiology Facilities and Services. Radiology 2023; 307:e221189. [PMID: 36472535 PMCID: PMC10068881 DOI: 10.1148/radiol.221189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 10/20/2022] [Accepted: 10/25/2022] [Indexed: 12/12/2022]
Affiliation(s)
- Tuna C Hayirli
- From the Harvard Medical School, Avenue Louis Pasteur, Boston, MA 02115 (T.C.H.); Harvard Business School, Boston, Mass (T.C.H.); Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Mass (C.B.W.); and Massachusetts Eye and Ear, Boston, Mass (C.B.W.)
| | - Chloe B Warinner
- From the Harvard Medical School, Avenue Louis Pasteur, Boston, MA 02115 (T.C.H.); Harvard Business School, Boston, Mass (T.C.H.); Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Mass (C.B.W.); and Massachusetts Eye and Ear, Boston, Mass (C.B.W.)
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Findeiss LK, Everett C, Azene E, Biggs K, Ignacio E, Matsumoto AH, Kay D, Kutsenko O, Liu R, Padha V, Soulez G, Swan T. Interventional Radiology Workforce Shortages Affecting Small and Rural Practices: A Report of the SIR/ACR Joint Task Force on Recruitment and Retention of Interventional Radiologists to Small and Rural Practices. J Am Coll Radiol 2022; 19:1322-1335. [PMID: 36216708 DOI: 10.1016/j.jacr.2022.08.004] [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: 07/26/2022] [Accepted: 08/04/2022] [Indexed: 12/04/2022]
Abstract
Radiology practices characterized as small and rural are challenged to recruit and retain interventional radiologists. Lack of access to interventional radiologic services results in a failure to meet the needs of patients, hospitals, and other community stakeholders. Acknowledging this challenge, the ACR's Commission on General, Small, Emergency and/or Rural Practice and Commission on Interventional and Cardiovascular Imaging and the Society of Interventional Radiology partnered to establish a joint task force to study this issue and identify strategies the ACR and the Society of Interventional Radiology should take to improve small and rural practice recruitment and retention of interventional radiologists. This report describes the deliberations and recommendations of the task force.
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Affiliation(s)
- Laura K Findeiss
- Chief of Radiology, Grady Health System, Emory University School of Medicine, Atlanta, Georgia.
| | - Catherine Everett
- Managing Partner, Coastal Radiology, New Bern, North Carolina; Member-at-Large, ACR Board of Chancellors; Associate Chief Medical Officer, Practice Analytics, RadPartners, El Segundo, California; and Secretary, American Association for Women Radiologists. https://twitter.com/cjeverett
| | - Ezana Azene
- Chair, Commission on Cancer, Gundersen Health System, La Crosse, Wisconsin. https://twitter.com/AceneMD
| | - Kelly Biggs
- Chief of Radiology, James E. VanZandt VA Medical Center, State College, Pennsylvania
| | - Elizabeth Ignacio
- Hawaii Pacific Health, Kahului, Hawaii; and Member, ACR Council Steering Committee. https://twitter.com/ElizabethAnnig1
| | - Alan H Matsumoto
- Chair and Theodore E. Keats Professor of Radiology, Department of Radiology and Medical Imaging, University of Virginia Health, Charlottesville, and Virginia; Vice Chair, ACR Board of Chancellors
| | - Dennis Kay
- System Chair, Department of Radiology, Ochsner Health, New Orleans, Louisiana
| | - Oleksandra Kutsenko
- Miami Cardiac and Vascular Institute, Miami, Florida. https://twitter.com/kutsenkoMD
| | - Ray Liu
- Massachusetts General Hospital, Boston, Massachusetts; and Vice President, Massachusetts General Brigham Global Advisory. https://twitter.com/rwliu
| | - Vivek Padha
- Chief of Radiology West Virginia University, Martinsburg, West Virginia
| | - Gilles Soulez
- Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada; Director of the Imaging and Engineering Research Axis, CHUM Research Center; and President, Canadian Association of Radiologists
| | - Tim Swan
- Marshfield Clinic Health System, Marshfield, Wisconsin; and Member-at-Large, ACR Board of Chancellors. https://twitter.com/TimSwanMD
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Utilisation of goals of care discussions and palliative care prior to image-guided procedures near the end of life. Clin Radiol 2022; 77:345-351. [PMID: 35177227 DOI: 10.1016/j.crad.2022.01.050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 01/19/2022] [Indexed: 11/03/2022]
Abstract
AIM To characterise image-guided procedures performed near the end of life and the use of goals of care discussions (GOC) and palliative care consultation (PCC) prior to these procedures. MATERIALS AND METHODS Retrospective chart review of 3,714 consecutive inpatient procedures performed for 2,351 patients and 8,206 outpatient procedures performed for 5,225 patients within a suburban medical system. Data were collected on demographics, procedures performed, mortality, and use of GOC or PCC prior to the procedures. Procedures near the end of life were classified as emergent, elective, or palliative. Logistic regression was used to assess for demographic disparities in care. RESULTS Nine percent of inpatients died within 30 days of their procedure, 57% of which were within the same hospitalisation. Of these patients, 59% had a documented GOC and 35% had a PCC. Similarly, 7% of outpatients died within 6 months of their procedure. A minority of these patients had a documented GOC (37%) or PCC (13%). There were few statistically significant demographic disparities in this care and the associated odds ratios were small. CONCLUSION A wide array of image-guided procedures is performed near the end of life. GOC and PCC are underutilised prior to these procedures. Few demographic disparities exist in this care.
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Enzmann D. Trends that Impact IR's Future. ROFO-FORTSCHR RONTG 2021; 194:21-28. [PMID: 34139780 DOI: 10.1055/a-1502-7663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The future of IR will evolve as a result of current trends in advances in medicine, disease biology, technology, and IR devices and accoutrements. Changes in the trends that lie at the center of the differentiation of IR from other treatment specialties will have the greatest impact. Differentiation revolves around image guidance knowledge and procedural treatment skills and involves three key components: access, mapping, and action, all of which have the common thread of imaging knowledge. The main trends that are discussed are: image-guided diagnostics (IgDx), image-guided treatment (IgRx), sub-specialization in IgRx, large device design for IgRx, multimodality IgRx, interdisciplinary IgRx, and decentralized IgRx growth. Success in attaining a patient-facing "front-line" patient position will determine the future not only of IR but of radiology as a field. IgRx is anti-commoditization immunization. KEY POINTS:: · It is useful to conceptually separate diagnostic (IgDx) and treatment (IgRx) IR procedures.. · Subspecialization in IgRx will innovate IR practices for all practitioners.. · Advances in IR-tailored imaging equipment and integration of multimodality imaging will create, expand, and facilitate new treatments.. · Other treatment disciplines will be integrated into IgRx in a complementary fashion.. · Expansion of IR services into outpatient imaging sites and outpatient clinics will help establish important direct patient care.. · The adoption of these trends will follow a "diffusion of innovations" sigmoid curve pattern spanning different time intervals.. CITATION FORMAT: · Enzmann D. Trends that Impact IR's Future. Fortschr Röntgenstr 2022; 194: 21 - 28.
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