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Costs of CT

Department of Radiology, FH 210, Massachusetts General Hospital, Fruit Street, Boston, MA 02114, e-mail: rhea.james@mgh.harvard.edu

Editor:

This letter is a response to the article by Dr Saini and colleagues in the January 2001 issue of Radiology (1).

Dr Saini and colleagues refer to an article by Rhea et al (2). Dr Saini states that "costs for departmental resources, such as scheduling, nursing, and hospital overhead ... were allocated to individual modalities on the basis of its percentage of department RVUs [relative value units]." This statement is incorrect. In our article, hospital overhead was allocated on the basis of direct costs of computed tomography (CT) as a percentage of the departmental total direct cost.

Furthermore, Dr Saini and colleagues suggest that the use of RVUs to allocate shared departmental costs, such as scheduling and nursing, results in an overallocation of costs to CT. They state that the use of a percentage of examinations "may by more appropriate" as a method of allocation. The use of RVUs may result in an overallocation of costs to CT, but the use of a percentage of examinations would result in an underallocation of costs to CT. The rationale for using RVUs in our article was that the average CT examination tends to be more complex in scheduling and uses more nursing services than most other examinations in the department, such as conventional radiography or ultrasonography.

There are two general points for the reader to consider. First, cost accounting is inexact. Allocation of hospital and departmental overhead items is one source of inaccuracy. The more accurate the accounting data, the more expensive it is to collect. Accounting data must be sufficiently accurate to making good management decisions based on approximate costs of our examinations. Assumptions and methods of allocation of costs must be specifically and correctly stated when investigations are compared so that the reader can judge whether the costs used in the investigation are reasonable. Second, regardless of the cost-accounting details, the cost of CT to the hospital is lower than that thought by many people, including some of our clinical colleagues who want to cut costs by reducing the use of CT. The cost of CT is lower than that of many other hospital resources, such as a day in the hospital or exploratory surgery. In many instances, the use of CT saves the hospital money because it results in a fast and accurate diagnosis, and it decreases use of other more costly hospital resources.

REFERENCES

1. Saini S, Sharma R, Levine LA, Barmson RT, Jordan PF, Thrall JH. Technical cost of CT examinations. Radiology 2001; 218:172-175.[Abstract/Free Full Text]
2. Rhea JT, Rao PM, Novelline RA, McCabe CJ. A focused appendiceal CT technique to reduce the cost of caring for patients with clinically suspected appendicitis. AJR Am J Roentgenol 1997; 169:113-118.[Abstract/Free Full Text]

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