title: Spiral noncontrast CT versus combined plain radiography and renal US after extracorporeal shock wave lithotripsy: cost-identification analysis.
abstract: OBJECTIVE
  To investigate the costs of spiral computed tomography (CT) versus those of combined plain radiography and renal ultrasound (US) in screening for postprocedural complications after extracorporeal shock wave lithotripsy (ESWL).
  
  
  METHODS
  Twenty-five adult patients who had undergone ESWL were prospectively examined with spiral CT, renal US, and plain abdominal radiography. Each examination was timed, and direct technical costs were calculated by using a procedural-based cost-accounting system. The combined cost of US and plain radiography was compared with the cost of spiral CT.
  
  
  RESULTS
  The average time for spiral CT was 15.3 minutes compared with 37.2 minutes for combined US and plain radiography. The direct technical cost of spiral CT was $36.86 compared with $57.60 for combined US and plain radiography. Average examination times were varied to assess the effect on overall costs. Within reasonable time ranges, combined US and plain radiography cannot be cost equivalent to spiral CT.
  
  
  CONCLUSIONS
  Spiral CT is faster and is associated with less direct technical cost than combined US and plain radiography when used to examine patients after ESWL, given the dependence of this model on time of examination. Further studies are needed to assess the relative accuracy of these alternative approaches.
authors.affiliation: Division of Radiology, The Cleveland Clinic Foundation, OH 44195, USA.
authors.forename: E M
authors.initials: EM
authors.lastname: Remer
authors.forename: B R
authors.initials: BR
authors.lastname: Herts
authors.forename: S B
authors.initials: SB
authors.lastname: Streem
authors.forename: D P
authors.initials: DP
authors.lastname: Hesselink
authors.forename: D A
authors.initials: DA
authors.lastname: Shiesly
authors.forename: A J
authors.initials: AJ
authors.lastname: Yost
authors.forename: M E
authors.initials: ME
authors.lastname: Baker
mesh_terms: D000328:Adult; D000368:Aged; D003362:Cost-Benefit Analysis; D004180:Direct Service Costs; D005260:Female; D017721:Hospital Costs; D006801:Humans; D008096:Lithotripsy / Q000009:adverse effects*; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D011446:Prospective Studies; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013997:Time Factors; D014057:Tomography, X-Ray Computed / Q000191:economics*; D014463:Ultrasonography; D014545:Urinary Calculi / Q000000981:diagnostic imaging*; D014567:Urography / Q000191:economics*