[Complexity index and analysis of digestive endoscopies at a university hospital].
BACKGROUND
In Spain neither the cost of digestive endoscopies nor the complexity index (CI) have been objectively estimated. Consequently, the profitability of an endoscopy unit cannot be evaluated.


OBJECTIVE
1: To classify endoscopies according to the time taken to accomplish them in order to estimate the CI and determine the relative value unit (RVU). 2: To evaluate the cost of each examination in order to determine the profitability of endoscopy as a diagnostic and therapeutic tool. 3: To measure unnecessary delays in examinations and to determine whether there are differences in the time an examination takes according to the endoscopist's experience and the patient's age or sex.


METHODS
The cost per hour of an endoscopy room was estimated by dividing the cost per year of employees, equipment, maintenance and the hospital's general costs between the hours of work per year of the endoscopy team. The time taken to perform endoscopies was estimated and the result was used to calculate the RVI, the CI and the cost of 500 consecutive endoscopies.


RESULTS
The annual cost amounted to 349,617.69 E. Staffing costs represented 65.5%, of which 56.3% were direct costs. Gastroscopy was taken as the RVU (cost = 27.52 E). Anoscopy was the simplest procedure (RVU = 0.61, cost = 15.08 E) and colonoscopy plus polypectomy was the most complex procedure (RVU = 4.41, cost = 74.28 E). The greater the experience of the member of staff performing the procedure, the less time it took (p < 0.01).


CONCLUSIONS
CI was lowest for anoscopy (URV = 0.61) and highest for total colonoscopy plus polypectomy (URV = 4.41). Cost and exploration time depended on the endoscopist's experience. Staff represented the highest percentage of cost.
Cantero Perona
J
J
Sección de Endoscopia. Servicio de Medicina Digestiva. Hospital Universitario de la Princesa. Universidad Autónoma de Madrid. Spain.
Valbuena González
M
M
Briz Romero
M R
MR
González Moreno
L
L
Maté Jiménez
J
J
D003365:Costs and Cost Analysis; D016145:Endoscopy, Digestive System / Q000145:classification / Q000191:economics*; D006785:Hospitals, University; D006801:Humans; D011446:Prospective Studies; D013030:Spain