title: Cost Accounting as a Tool for Increasing Cost Transparency in Selective Hepatic Transarterial Chemoembolization.
abstract: OBJECTIVE
  To increase cost transparency and uncover potential areas for savings in patients receiving selective transarterial chemoembolization at a tertiary care academic center.
  
  
  METHODS
  The hospital cost accounting system charge master sheet for direct and total costs associated with selective transarterial chemoembolization in fiscal years 2013 and 2014 was queried for each of the four highest volume interventional radiologists at a single institution. There were 517 cases (range, 83-150 per physician) performed; direct costs incurred relating to care before, during, and after the procedure with respect to labor, supply, and equipment fees were calculated.
  
  
  RESULTS
  A median of 48 activity codes were charged per selective transarterial chemoembolization from five cost centers, represented by the angiography suite, units for care before and after the procedure, pharmacy, and observation floors. The average direct cost of selective transarterial chemoembolization did not significantly differ among operators at $9,126.94, $8,768.77, $9,027.33, and $8,909.75 (P = .31). Intraprocedural costs accounted for 82.8% of total direct costs and provided the greatest degree in cost variability ($7,268.47-$7,691.27). The differences in intraprocedural expense among providers were not statistically significant (P = .09), even when separated into more specific procedure-related labor and supply costs.
  
  
  CONCLUSIONS
  Cost accounting systems could effectively be interrogated as a method for calculating direct costs associated with selective transarterial chemoembolization. The greatest source of expenditure and variability in cost among providers was shown to be intraprocedural labor and supplies, although the effect did not appear to be operator dependent.
authors.affiliation: Division of Interventional Radiology, Stanford University Medical Center, 300 Pasteur Drive, Room H3630, MC: 5642, Stanford, CA 95305. Electronic address: osman1423@gmail.com.
authors.forename: Osman
authors.initials: O
authors.lastname: Ahmed
authors.affiliation: Department of Radiology, University of Chicago Medicine, Chicago, Illinois.
authors.forename: Mikin
authors.initials: M
authors.lastname: Patel
authors.affiliation: Division of Interventional Radiology, Stanford University Medical Center, 300 Pasteur Drive, Room H3630, MC: 5642, Stanford, CA 95305.
authors.forename: Thomas
authors.initials: T
authors.lastname: Ward
authors.affiliation: Division of Interventional Radiology, Stanford University Medical Center, 300 Pasteur Drive, Room H3630, MC: 5642, Stanford, CA 95305.
authors.forename: Daniel Y
authors.initials: DY
authors.lastname: Sze
authors.affiliation: Department of Anesthesiology, Stanford University Medical Center, 300 Pasteur Drive, Room H3630, MC: 5642, 300 Pasteur Drive, Room H3630, MC: 5642, Stanford, CA 95305.
authors.forename: Kristen
authors.initials: K
authors.lastname: Telischak
authors.affiliation: Division of Interventional Radiology, Stanford University Medical Center, 300 Pasteur Drive, Room H3630, MC: 5642, Stanford, CA 95305.
authors.forename: Nishita
authors.initials: N
authors.lastname: Kothary
authors.affiliation: Division of Interventional Radiology, Stanford University Medical Center, 300 Pasteur Drive, Room H3630, MC: 5642, Stanford, CA 95305.
authors.forename: Lawrence V
authors.initials: LV
authors.lastname: Hofmann
mesh_terms: D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000191:economics; D002140:California / Q000453:epidemiology; D006528:Carcinoma, Hepatocellular / Q000191:economics* / Q000628:therapy*; D016461:Chemoembolization, Therapeutic / Q000191:economics*; D003365:Costs and Cost Analysis / Q000379:methods; D030881:Disclosure / Q000706:statistics & numerical data; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006499:Hepatic Artery; D006801:Humans; D008113:Liver Neoplasms / Q000191:economics* / Q000453:epidemiology / Q000628:therapy*; D008297:Male; D018803:Models, Economic; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents