Appropriate use of interventional radiology is cost-effective
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Appropriate Use of Interyentional Radiology Is Cost-Effective LennyTan, MD From the Department of Diagnostic Radiology, Na- tional University of Singapore, Singapore. Address reprint requests to L. Tan, MD, Depart- ment of Diagnostic Radiology, National University of Singapore, Lower Kent Ridge Rd., Singapore 051t, Singapore. Acad Radio11996;3:S109-$110 1996, Association of University Radiologists R adiology has expanded tremendot, sly in recent decades in terms of capability and of patient care. The many new techniques are finding more and more clinical applications. Unfortunately, in an era of heightened sensitivity to health care costs, the "high-tech" equipment associated with radiology causes it to be perceived as an expensive department. Another unfortunate outcome of rapid technological advance is the constant pres- sure to upgrade and replace equipment, contributing again to rising costs. Institutions in which tile radiology department is a significant source of income have few complaints. In practices in which funding is largely gov- ernmental, however, concern has been focused on radiology, where it is difficult to evaluate the true benefits to patient care and cost savings. Singapore is a small island nation of 3 million people who enjoy a high standard of IMng and a high level of health care. As a result of sustained steady growth over tile },ears, its citizens have come to expect the best, not just the most updated heahh care protocols and equipment but its ready availability. Health care funding in Singapore is largely governmental. An important underlying principle is that of copayment. In other words, patients them- selves are responsible for a portion of their health care costs. The Medisave program is a system of savings designed to ensure that patients have those funds available when needed. Patients therefore enjoy a wide range of choices depending on their financial means and willingness to pay. I have found that the availability of new diagnostic imaging techniques such as sonography, computed tomogmphy (CT) scanning, and magnetic resonance imaging, definitely reduces the time needed to arrive at a diag- nosis. The advantages of these techniques, however, are always indirect and difficult to quantify. Logic would dictate that early diagnosis, which leads to early treatment--and a better outcome, shorter hospital stay, and earlier return to work--also leads to significant cost savings. In addition, a more accurate diagnosis also enhances the physician's ability to inform his or her patients about potential outcomes. One aspect of mdiologic practice that stands out in the considemtkm of costs and benefits is interventional radiology. The following clinical exam- ples---t pulmonary nodule and a liver abscess--help illustrate this point. $109
Transcript of Appropriate use of interventional radiology is cost-effective
Appropriate Use of Interyentional Radiology Is Cost-Effective
LennyTan, MD
From the Department of Diagnostic Radiology, Na- tional University of Singapore, Singapore.
Address reprint requests to L. Tan, MD, Depart- ment of Diagnostic Radiology, National University of Singapore, Lower Kent Ridge Rd., Singapore 051t, Singapore.
Acad Radio11996;3:S109-$110 �9 1996, Association of University Radiologists
R adiology has expanded tremendot, sly in recent decades in terms of capability and of patient care. The many new techniques are finding
more and more clinical applications. Unfortunately, in an era of heightened sensitivity to health care costs, the "high-tech" equipment associated with radiology causes it to be perceived as an expensive department. Another unfortunate outcome of rapid technological advance is the constant pres- sure to upgrade and replace equipment, contributing again to rising costs.
Institutions in which tile radiology department is a significant source of income have few complaints. In practices in which funding is largely gov- ernmental, however, concern has been focused on radiology, where it is
difficult to evaluate the true benefits to patient care and cost savings.
Singapore is a small island nation of 3 million people who enjoy a high standard of IMng and a high level of health care. As a result of sustained
steady growth over tile },ears, its citizens have come to expect the best, not just the most updated heahh care protocols and equipment but its ready availability.
Health care funding in Singapore is largely governmental. An important underlying principle is that of copayment . In other words, patients them-
selves are responsible for a portion of their health care costs. The Medisave program is a system of savings designed to ensure that patients have those funds available when needed. Patients therefore enjoy a wide range of choices depending on their financial means and willingness to pay.
I have found that the availability of new diagnostic imaging techniques such as sonography, computed tomogmphy (CT) scanning, and magnetic resonance imaging, definitely reduces the time needed to arrive at a diag- nosis. The advantages of these techniques, however, are always indirect and difficult to quantify. Logic would dictate that early diagnosis, which leads to early t rea tment - -and a better outcome, shorter hospital stay, and earlier return to work- -a l so leads to significant cost savings. In addition, a more accurate diagnosis also enhances the physician's ability to inform his
or her patients about potential outcomes. One aspect of mdiologic practice that stands out in the considemtkm of
costs and benefits is interventional radiology. The following clinical exam- ples---t pulmonary nodule and a liver abscess- -help illustrate this point.
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TAN VoI. 3, Suppl. 1, April 1996
PULMONARY NODULE
A patient with a solitary pulmonary nodule seen on a chest radiograph can be given a work'up entirely within the radiology department in a matter of hours. A CT scan of the thorax and the upper part of the abdomen is nsed to localize the lesion and to evaluate its characteristics. The mediastinum also is visualized during this procedure, facilitating decisions, treatment, and prognosis. A fine-nee- dle aspiration biopsy is done during the same session, and the results can be made available the same day. All these procedures can be done on an outpatient basis, generat- ing further cost savings.
Other scenarios that might be used for the same clin- ical problem are (1) treatment by antibiotics or antitu- berculous drugs, but only if infection is strongly suspected, and (2) surgical removal and histologic eval- uation of the nodule.
A comparison of the costs involved in the different approaches sliows that management in the radiology department (CT examination of the thorax with biopsy and histology):costs $480, whereas the charges for surgi- cal treatment (CT scan of the thorax for staging, operat- ing room and :surgeon's and anesthesiologist's charges, hospitalizationcharges [for 7 days], histology charges, follow-up chest radiographs, and antibiotic prophylaxis) are $3,500. Not only is interventional radiology more
t
economical (by a factor of 7.3), but fine-needle aspira- tion biopsy is much less traumatic for the patient.
LIVER ABSCESS
Small hepatic abscesses are normally treated with anti- biotics and do not require drainage. This regimen requires a long hospital stay, however, sometimes as
long as 3 weeks. The cost to the patient is approximately $8,200 (3-week stay in the hospital, 2-week course of antibiotics, follow-up sonogmphy, phy:sicians' fees, and laboratory fees). If the abscess is large, drainage is neces- sary and can be accomplished either by interventional radiology or by surgery. A comparison of the costs for these two alternatives shows that management by interventional radiology (CT scan and drainage, a 1- week course of antibiotics, laboratory fees, and a 1-week hospital stay) costs S2,800, whereas surgical treatment (operating room and surgeon's and anesthesiologist's charges, a 2-week hospital stay, a 2-week course of anti- biotics, laboratory tests, chest radiographs, and tWO sonographic examinations) costs $5,800. Again, in addi- tion to the substantial savings realized by using interven- tional radiology, the experience for tile patient is much different. With interventional radiology, the fever usually settles within 24-48 hr, pain is reduced, the choice of antibiotic can be based on culture and sensitivity of the pus from the abscess, there is no pain from incision, no stitches need to be removed, no general anesthesia is used, and the hospital stay is considerably shorter. Fur- thermore, no adhesions are formed, and it is more cer- tain that the drainage catheter is properly placed within the cavity of the abscess. Less trauma and earlier recov- ery and return to work are two more advantages.
The list of radiologic procedures being expanded to include treatment as well as diagnosis is growing steadily. These procedures are clearly cost-effective and greatly beneficial to the patient, and they may well be the forerunners of a better understanding and apprecia- tion of the contribution that radiology and its tech- niques offer today's heahh care consumer.
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