Tay Yi Xiang, Ong Marcus Eh, Foley Shane J, Chen Robert Chun, Chan Lai Peng, Killeen Ronan, Mak May San, McNulty Jonathan P, Sanjeewa Kularatna
Radiography Department, Allied Health Division, Singapore General Hospital,Outram Road, Singapore 169608, Singapore.
Radiography and Diagnostic Imaging, School of Medicine, University College Dublin, Belfield, Dublin, Ireland.
Eur J Radiol Open. 2024 Oct 19;13:100605. doi: 10.1016/j.ejro.2024.100605. eCollection 2024 Dec.
There is a lack of clear and consistent cost reporting for cost-effectiveness analysis in radiology. Estimates are often obtained using costing derived from hospital charge records. This study aims to evaluate the accuracy of hospital charge records compared to a Singapore hospital's true diagnostic imaging costs.
A seven-step process involving a bottom-up micro-costing approach was devised and followed to calculate the cost of imaging using actual data from a clinical setting. We retrieved electronic data from a random sample of 96 emergency department patients who had CT brain, CT and X-ray cervical spine, and X-ray lumbar spine performed to calculate the parameters required for cost estimation. We adjusted imaging duration and number of performing personnel to account for variations.
Our approach determined the average cost for the following imaging procedures: CT brain (€154.00), CT and X-ray cervical spine (€177.14 and €68.22), and X-ray lumbar spine (€79.85). We found that the true cost of both conventional radiography procedures was marginally higher than the subsidized patient charge, and all costs were slightly lower than the private patient charge except for X-ray lumbar spine (€73.49 vs.€79.85). We identified larger differences in cost for both CT procedures and smaller differences in cost for conventional radiography procedures, depending on the patient's private or subsidized status. For private status, the differences were: CT brain (Min: €194.20; Max: €264.40), CT cervical spine (Min: €219.54; Max: €399.05), X-ray cervical spine (Min: €5.27; Max: €61.94), and X-ray lumbar spine (Min: €6.36; Max: €108.04), while for subsidized status, the differences were: CT brain (Min: €7.56; Max: €62.64), CT cervical spine (Min: €47.02; Max: €132.49), X-ray cervical spine (Min: €15.88; Max: €103.44), and X-ray lumbar spine (Min: €13.66; Max: €149.44). Considering examination duration and the number of personnel engaged in a procedure, there were significant variations in the minimum, average, and maximum imaging costs.
There is a modest gap between hospital charges and actual costs, and we must therefore exercise caution and recognize the limitations of utilizing hospital charge records as absolute metrics for cost-effectiveness analysis Our detailed approach can potentially enable more accurate imaging cost determination for future studies.
在放射学的成本效益分析中，缺乏清晰且一致的成本报告。成本估算通常是利用源自医院收费记录的成本核算得出。本研究旨在评估与新加坡一家医院的真正诊断成像成本相比，医院收费记录的准确性。
设计并遵循了一个包含自下而上微观成本核算方法的七步骤流程，以使用来自临床环境的实际数据来计算成像成本。我们从96名急诊科患者的随机样本中检索电子数据，这些患者进行了脑部CT、颈椎CT和X线检查以及腰椎X线检查，以计算成本估算所需的参数。我们调整了成像时长和执行人员数量以考虑差异。
我们的方法确定了以下成像检查的平均成本：脑部CT（154.00欧元）、颈椎CT和X线检查（分别为177.14欧元和68.22欧元）以及腰椎X线检查（79.85欧元）。我们发现，两种传统放射检查的实际成本略高于补贴患者收费，除腰椎X线检查外（73.49欧元对79.85欧元），所有成本均略低于自费患者收费。根据患者的自费或补贴状态，我们发现CT检查的成本差异较大，而传统放射检查的成本差异较小。对于自费状态，差异分别为：脑部CT（最小值：194.20欧元；最大值：264.40欧元）、颈椎CT（最小值：219.54欧元；最大值：399.05欧元）、颈椎X线检查（最小值：5.27欧元；最大值：61.94欧元）以及腰椎X线检查（最小值：6.36欧元；最大值：108.04欧元），而对于补贴状态，差异分别为：脑部CT（最小值：7.56欧元；最大值：62.64欧元）、颈椎CT（最小值：47.02欧元；最大值：132.49欧元）、颈椎X线检查（最小值：15.88欧元；最大值：103.44欧元）以及腰椎X线检查（最小值：13.66欧元；最大值：149.44欧元）。考虑到检查时长和参与一项检查的人员数量，最小、平均和最大成像成本存在显著差异。
医院收费与实际成本之间存在适度差距，因此我们必须谨慎行事，并认识到将医院收费记录用作成本效益分析的绝对指标的局限性。我们详细的方法可能会使未来的研究能够更准确地确定成像成本。
