Alonso Gutiérrez M, Tascón Pérez J, Andreu Dussac J, González-Trevilla A
Servicio de Cardiología-Hemodinámica, Hospital 12 de Octubre, Madrid.
Rev Esp Cardiol. 1995 Apr;48(4):245-54.
The main objective of this study is to know actual hemodynamic explorations costs in Spain, not only direct but total imputation costs, through a registration of duration, resources and disposables used in this minimally invasive exploration. Also to explore the variability in costs and consumptions between hospitals with similar technology in catheterization practice.
The effective duration, supplies consumptions and manpower resources utilized in 762 diagnostic catheterization, 217 therapeutic coronarographies, and 32 Inoue mitral valvotomies have been registered and analyzed in four public Spanish hospitals. The direct costs have been calculated through purchase and repair bills and officials wages. The indirect ones through repercussion judgements, and the amortization on a ten years imputation process.
The consumption, duration and manpower data are shown with media and standard deviations. Final costs are: 106,879 pesetas for a diagnostic catheterization, 545,614 pesetas for a therapeutic coronarography, and 556,315 pesetas for a mitral Inoue valvotomy. Significative differences have been demonstrated between hospitals affecting the majority of consumption and manpower variables. There are also wide differences on indirect costs, amortization and maintenance costs.
The catheterization costs are high in Spain mainly due to disposable material costs in spite of low manpower costs in public hospitals. The indirect administration costs are of relative importance in diagnostic catheterization, but in the therapeutic ones the only important payment are the disposable material costs who get the 85% of total cost. The differences between hospitals in durations and consumptions show the need to improve medical protocols. The differences in indirect costs reflect different steps in implementation of hospital management tools.
本研究的主要目的是通过记录这种微创检查所使用的持续时间、资源和一次性用品，了解西班牙实际的血流动力学检查成本，不仅包括直接成本，还包括总估算成本。同时，探索在导管插入术实践中技术相似的医院之间成本和消耗的差异。
在西班牙的四家公立医院，对762例诊断性导管插入术、217例治疗性冠状动脉造影术和32例井上二尖瓣切开术所使用的有效持续时间、耗材消耗和人力资源进行了记录和分析。直接成本通过采购和维修账单以及官员工资来计算。间接成本通过影响判断以及十年估算过程中的摊销来计算。
消耗、持续时间和人力数据以中位数和标准差表示。最终成本为：诊断性导管插入术106,879比塞塔，治疗性冠状动脉造影术545,614比塞塔，井上二尖瓣切开术556,315比塞塔。已证明不同医院之间存在显著差异，影响了大多数消耗和人力变量。间接成本、摊销和维护成本也存在很大差异。
在西班牙，导管插入术成本高昂，主要原因是一次性材料成本，尽管公立医院人力成本较低。间接管理成本在诊断性导管插入术中具有相对重要性，但在治疗性导管插入术中，唯一重要的支出是一次性材料成本，占总成本的85%。医院之间在持续时间和消耗方面的差异表明需要改进医疗方案。间接成本的差异反映了医院管理工具实施中的不同步骤。
