title: A cost simulation for mammography examinations taking into account equipment failures and resource utilization characteristics.
abstract: OBJECTIVE
  This work develops a cost analysis estimation for a mammography clinic, taking into account resource utilization and equipment failure rates.
  
  
  METHODS
  Two standard clinic models were simulated, the first with one mammography equipment, two technicians and one doctor, and the second (based on an actually functioning clinic) with two equipments, three technicians and one doctor. Cost data and model parameters were obtained by direct measurements, literature reviews and other hospital data. A discrete-event simulation model was developed, in order to estimate the unit cost (total costs/number of examinations in a defined period) of mammography examinations at those clinics. The cost analysis considered simulated changes in resource utilization rates and in examination failure probabilities (failures on the image acquisition system). In addition, a sensitivity analysis was performed, taking into account changes in the probabilities of equipment failure types.
  
  
  RESULTS
  For the two clinic configurations, the estimated mammography unit costs were, respectively, US$ 41.31 and US$ 53.46 in the absence of examination failures. As the examination failures increased up to 10% of total examinations, unit costs approached US$ 54.53 and US$ 53.95, respectively. The sensitivity analysis showed that type 3 (the most serious) failure increases had a very large impact on the patient attendance, up to the point of actually making attendance unfeasible.
  
  
  CONCLUSIONS
  Discrete-event simulation allowed for the definition of the more efficient clinic, contingent on the expected prevalence of resource utilization and equipment failures.
authors.affiliation: CEFET, Rio de Janeiro, Brazil.
authors.forename: Fernando C
authors.initials: FC
authors.lastname: Coelli
authors.forename: Renan M V R
authors.initials: RM
authors.lastname: Almeida
authors.forename: Wagner C A
authors.initials: WC
authors.lastname: Pereira
mesh_terms: D001938:Brazil; D003198:Computer Simulation; D003365:Costs and Cost Analysis / Q000379:methods; D004868:Equipment Failure / Q000706:statistics & numerical data; D005260:Female; D006295:Health Resources / Q000706:statistics & numerical data; D006801:Humans; D008327:Mammography / Q000191:economics*; D018803:Models, Economic; D040841:Resource Allocation