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Health Policy and Practice |
1 From the Department of Radiology, Stanford University School of Medicine, Stanford, CA 94305-5105. Received February 26, 1999; revision requested May 5; revision received August 18; accepted September 24. Supported in part by GE-AUR Radiology Research Fellowship; National Institutes of Health grants R01HL50305, 1P41-RR09784, and LM07033; the Lucas Foundation; and the Phil N. Allen Trust. Address reprint requests to G.D.R. (e-mail: grubin@stanford.edu).
PURPOSE: To compare the costs of performing helical computed tomographic (CT) angiography with three-dimensional rendering versus intraarterial digital subtraction angiography (DSA) for preoperative imaging of abdominal aortic aneurysms (AAAs).
MATERIALS AND METHODS: A single observer determined the variable direct costs of performing nine intraarterial DSA and 10 CT angiographic examinations in age- and general health–matched patients with AAA by using time and motion analyses. All personnel directly involved in the cases were tracked, and the involvement times were recorded to the nearest minute. All material items used during the procedures were recorded. The cost of labor was determined from personnel reimbursement data, and the cost of materials, from vendor pricing. The variable direct costs of laboratory tests and using the ambulatory treatment unit for postprocedural monitoring, as well as all fixed direct costs, were assessed from hospital accounting records. The total costs were determined for each procedure and compared by using the Student t test and calculating the CIs.
RESULTS: The mean total direct cost of intraarterial DSA (± SD) was $1,052 ± 71, and that of CT angiography was $300 ± 30, which are significantly different (P < 4.1 x 10-11). With 95% confidence, intraarterial DSA cost 3.2–3.7 times more than CT angiography for the assessment of AAA.
CONCLUSION: Assuming equal diagnostic utility and procedure-related morbidity, institutions may have substantial cost savings whenever CT angiography can replace intraarterial DSA for imaging AAAs.
Index terms: Aneurysm, aortic, 981.73 • Computed tomography (CT), angiography, 981.12912, 981.12916 • Cost-effectiveness • Digital subtraction angiography, comparative studies, 981.122
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