title: Economic analysis of bedside ultrasonography (US) implementation in an Internal Medicine department.
abstract: The economic crisis, the growing healthcare demand, and Defensive Medicine wastefulness, strongly recommend the restructuring of the entire medical network. New health technology, such as bedside ultrasonography, might successfully integrate the clinical approach optimizing the use of limited resources, especially in a person-oriented vision of medicine. Bedside ultrasonography is a safe and reliable technique, with worldwide expanding employment in various clinical settings, being considered as "the stethoscope of the 21st century". However, at present, bedside ultrasonography lacks economic analysis. We performed a Cost-Benefit Analysis "ex ante", with a break-even point computing, of bedside ultrasonography implementation in an Internal Medicine department in the mid-term. Number and kind estimation of bedside ultrasonographic studies were obtained by a retrospective study, whose data results were applied to the next 3-year period (foresight study). All 1980 foreseen bedside examinations, with prevailing multiorgan ultrasonographic studies, were considered to calculate direct and indirect costs, while specific and generic revenues were considered only after the first semester. Physician professional training, equipment purchase and working time represented the main fixed and variable cost items. DRG increase/appropriateness, hospitalization stay shortening and reduction of traditional ultrasonography examination requests mainly impacted on calculated revenues. The break-even point, i.e. the volume of activity at which revenues exactly equal total incurred costs, was calculated to be 734 US examinations, corresponding to € 81,998 and the time considered necessary to reach it resulting 406 days. Our economic analysis clearly shows that bedside ultrasonography implementation in clinical daily management of an Internal Medicine department can produce consistent savings, or economic profit according to managerial choices (i.e., considering public or private targets), other than evident medical benefits.
authors.affiliation: Internal Medicine Unit, "Madonna delle Grazie" Clinic, viale S. D'Acquisto 67, 00040, Velletri (Rome), Italy. americotesta@gmail.com.|, Via dei Laghi, 32, 00040, Rocca di Papa, Rome, Italy. americotesta@gmail.com.
authors.forename: Americo
authors.initials: A
authors.lastname: Testa
authors.affiliation: Department of Economics and Management, University of Trento, via Calepina, 14, 38122, Trento, Italy.|Public Policy and Management Department, SDA Bocconi University, via Roberto Sarfatti 25, 20100, Milan, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Francesconi
authors.affiliation: Emergency Medicine Department, "A. Gemelli" University Hospital, l.go A. Gemelli 8, 00168, Rome, Italy.
authors.forename: Rosangela
authors.initials: R
authors.lastname: Giannuzzi
authors.affiliation: Internal Medicine Unit, "A. Fiorini" Hospital, via Firenze 1, 04019, Terracina (LT), Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Berardi
authors.affiliation: Department of Systems Medicine, University of Rome "Tor Vergata", Via Montpellier 1, 00133, Rome, Italy.|Internal Medicine Unit, University Hospital Policlinico Tor Vergata, Viale Oxford 81, 00133, Rome, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Sbraccia
mesh_terms: D003365:Costs and Cost Analysis; D006748:Hospital Departments; D006801:Humans; D007388:Internal Medicine; D007558:Italy; D019095:Point-of-Care Systems / Q000191:economics*; D012189:Retrospective Studies; D014463:Ultrasonography / Q000191:economics*
keywords: Bedside ultrasonography; Costs benefit analysis; Echoscopy; Economic analysis; Internal Medicine; Point of care ultrasonography