Cost identification of abdominal aortic aneurysm imaging by using time and motion analyses.
OBJECTIVE
To compare the costs of performing helical computed tomographic (CT) angiography with three-dimensional rendering versus intraarterial digital subtraction angiography (DSA) for preoperative imaging of abdominal aortic aneurysms (AAAs).


METHODS
A single observer determined the variable direct costs of performing nine intraarterial DSA and 10 CT angiographic examinations in age- and general health-matched patients with AAA by using time and motion analyses. All personnel directly involved in the cases were tracked, and the involvement times were recorded to the nearest minute. All material items used during the procedures were recorded. The cost of labor was determined from personnel reimbursement data, and the cost of materials, from vendor pricing. The variable direct costs of laboratory tests and using the ambulatory treatment unit for postprocedural monitoring, as well as all fixed direct costs, were assessed from hospital accounting records. The total costs were determined for each procedure and compared by using the Student t test and calculating the CIs.


RESULTS
The mean total direct cost of intraarterial DSA (+/- SD) was $1,052 +/- 71, and that of CT angiography was $300 +/- 30, which are significantly different (P < 4.1 x 10(-11)). With 95% confidence, intraarterial DSA cost 3.2-3.7 times more than CT angiography for the assessment of AAA.


CONCLUSIONS
Assuming equal diagnostic utility and procedure-related morbidity, institutions may have substantial cost savings whenever CT angiography can replace intraarterial DSA for imaging AAAs.
Rubin
G D
GD
Department of Radiology, Stanford University School of Medicine, Stanford, CA 94305-5105, USA. grubin@stanford.edu
Armerding
M D
MD
Dake
M D
MD
Napel
S
S
D000066:Accounting / Q000191:economics; D000368:Aged; D015901:Angiography, Digital Subtraction / Q000191:economics* / Q000295:instrumentation / Q000379:methods / Q000451:nursing; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging* / Q000451:nursing; D016022:Case-Control Studies; D016001:Confidence Intervals; D003287:Contrast Media / Q000191:economics; D017046:Cost Savings; D003365:Costs and Cost Analysis / Q000145:classification / Q000191:economics; D004180:Direct Service Costs / Q000145:classification; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000191:economics* / Q000295:instrumentation / Q000379:methods; D007755:Laboratories, Hospital / Q000191:economics; D008991:Monitoring, Physiologic / Q000191:economics; D010564:Personnel, Hospital / Q000191:economics; D011300:Preoperative Care; D011871:Radiology / Q000191:economics; D013996:Time and Motion Studies; D014057:Tomography, X-Ray Computed / Q000191:economics* / Q000295:instrumentation / Q000379:methods / Q000451:nursing; D000078329:Workforce
D003287:Contrast Media