title: Downstream hospital charges generated from endoscopic ultrasound procedures are greater than those from colonoscopies.
abstract: OBJECTIVE
  Endoscopic ultrasound is a clinically valuable endoscopic platform, although a potential barrier to its widespread use is the modest reimbursement to the hospital, compared with that of standard endoscopy. However, the downstream procedures generated by endoscopic ultrasound findings might offset its modest procedural reimbursement for a hospital or health care system. We compared the number of hospital procedures that resulted from endoscopic ultrasound findings with those from colonoscopy findings and also compared the downstream hospital charges generated by endoscopic ultrasounds with those from colonoscopies.
  
  
  METHODS
  We retrospectively reviewed data from 920 consecutive endoscopic ultrasounds and 920 consecutive colonoscopies performed at University Hospital in Cincinnati, Ohio to determine the downstream procedures generated within 18 months of the index procedure. Total hospital charges were determined for the index procedures, as well as all downstream surgeries, endoscopic procedures, and radiation therapy, chemotherapy, and interventional radiology procedures.
  
  
  RESULTS
  Endoscopic ultrasounds led to a greater number of downstream procedures than colonoscopies (198 vs 34). Hospital charges for downstream procedures that arose from endoscopic ultrasounds were 2.63-fold greater than those of colonoscopies ($4,068,115 vs $1,546,291). Hospital charges that resulted from the 920 index endoscopic ultrasounds were 1.34-fold greater than those of the index colonoscopies ($3,194,715 vs $2,381,745). Thus, the total hospital charges (index procedures plus downstream procedures) that arose from endoscopic ultrasounds were 1.85-fold greater than those of colonoscopies ($7,262,830 vs $3,928,036).
  
  
  CONCLUSIONS
  Endoscopic ultrasounds generate greater downstream hospital charges than colonoscopies. These downstream charges attenuate the higher procedure-related charges of colonoscopy for a hospital.
authors.affiliation: Division of Digestive Diseases, Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA. atkinsmw@ucmail.uc.edu
authors.forename: Matt
authors.initials: M
authors.lastname: Atkinson
authors.forename: Nathan
authors.initials: N
authors.lastname: Schmulewitz
mesh_terms: D003113:Colonoscopy / Q000191:economics*; D004358:Drug Therapy / Q000191:economics; D019160:Endosonography / Q000191:economics*; D005767:Gastrointestinal Diseases / Q000175:diagnosis / Q000191:economics* / Q000628:therapy*; D017722:Hospital Charges / Q000706:statistics & numerical data*; D006801:Humans; D009820:Ohio; D011878:Radiotherapy / Q000191:economics; D012189:Retrospective Studies; D013514:Surgical Procedures, Operative / Q000191:economics