title: [Clinical and economical comparison between in-house (Make) and outsourcing (Buy) management of the cardiac catheterization laboratory from two high-volume diagnostic and interventional centers: immediate and 6-month results].
abstract: BACKGROUND
  Percutaneous coronary interventions (PCI) are widespread procedures in the Italian Healthcare System, but concerns are raised about their economic sustainability. In the last decade, public hospitals have outsourced the PCI services (building and maintaining the technological instruments and the personnel) "buying" them from private companies (Buy) rather than building and maintaining them through public expenditure (Make). The aim of this study was to compare the economic and clinical impact of these two management solutions (Buy and Make) in two community hospitals located in the Turin metropolitan area (Italy).
  
  
  METHODS
  We conducted: 1) a quantitative assessment in order to compare differences in the economic impact between Buy and Make for providing PCI; 2) a qualitative assessment comparing the clinical characteristics of two inpatient populations undergoing PCI and then analyzing the efficacy of the procedure in-hospital and at 6-month follow-up.
  
  
  RESULTS
  Between January and June 2010, a total of 332 patients underwent PCI at the "degli Infermi" Hospital in Rivoli and 340 at the "Maria Vittoria" Hospital in Turin (Italy). There were no significant differences between the two populations neither about the clinical characteristics nor in procedural efficacy (either immediate or at follow-up). For 600 units of diagnostic-therapeutic pathway, the net present value at a discount rate of 3.5% of the Make project is higher than that of the Buy by €278.402,25, and is therefore the less convenient of the two solutions. The Buy solution is still the more convenient of the two at volumes <700 units.
  
  
  CONCLUSIONS
  Our findings show that the Buy solution, if tailored to the specific local needs, provides access to sophisticated technology without making worse quality of services and may save capital expenditure below 700 PCI/years.
authors.forename: Ferdinando
authors.initials: F
authors.lastname: Varbella
authors.forename: Davide
authors.initials: D
authors.lastname: Minniti
authors.forename: Riccardo
authors.initials: R
authors.lastname: Belli
authors.forename: Maria Rosaria
authors.initials: MR
authors.lastname: Gualano
authors.forename: Francesco
authors.initials: F
authors.lastname: Tomassini
authors.forename: Andrea
authors.initials: A
authors.lastname: Gagnor
authors.forename: Alfonso
authors.initials: A
authors.lastname: Gambino
authors.forename: Emanuele
authors.initials: E
authors.lastname: Tizzani
authors.forename: Nicolò
authors.initials: N
authors.lastname: Montali
authors.forename: Michele
authors.initials: M
authors.lastname: Ceruti
authors.forename: Maria Michela
authors.initials: MM
authors.lastname: Gianino
mesh_terms: D000368:Aged; D002201:Capital Expenditures; D006328:Cardiac Catheterization / Q000191:economics* / Q000295:instrumentation; D003327:Coronary Disease / Q000175:diagnosis / Q000191:economics / Q000453:epidemiology / Q000628:therapy; D017046:Cost Savings; D005260:Female; D006331:Heart Diseases / Q000401:mortality; D017052:Hospital Mortality; D006764:Hospitals, Community / Q000191:economics*; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D020416:Outsourced Services / Q000191:economics*; D062645:Percutaneous Coronary Intervention / Q000191:economics* / Q000295:instrumentation; D010564:Personnel, Hospital / Q000191:economics; D015397:Program Evaluation; D020521:Stroke / Q000453:epidemiology; D013675:Technology, High-Cost / Q000191:economics; D013997:Time Factors; D016896:Treatment Outcome