MR angiography versus intra-arterial digital subtraction angiography of the lower extremities: activity-based cost
F Stacul1, F Pozzi-Mucelli, E Lubin
1Unità Clinica Operativa di Radiologia, Università degli Studi di Trieste, Ospedale di Cattinara, Strada di Fiume 447, I1-34149 Trieste, Italy. fulvio.stacul@aots.sanita.fvg.it
Insights
Magnetic resonance angiography (MRA) is more cost-effective than intra-arterial digital subtraction angiography (DSA) for evaluating lower limb arterial disease. MRA offers a lower biological cost and is a more economical choice for diagnostic imaging.
Area of Science:
- Radiology
- Medical Imaging
- Health Economics
Background:
- Lower limb arterial disease requires accurate diagnostic imaging.
- Magnetic resonance angiography (MRA) and intra-arterial digital subtraction angiography (DSA) are used for diagnosis.
- Cost-effectiveness of diagnostic procedures is crucial for healthcare resource allocation.
Purpose of the Study:
- To analyze and compare the costs of MRA and intra-arterial DSA within the radiology department.
- To evaluate the economic implications of choosing between MRA and DSA for lower limb arterial disease assessment.
Main Methods:
- Differential costs (equipment, variable, personnel) and common costs were calculated for both MRA and DSA.
- Full costs were determined by summing differential and common costs for each procedure.
- The study focused solely on costs incurred within the radiology department.
Main Results:
- The full cost of MRA was €191.76, while intra-arterial DSA cost €243.80, making DSA 27.1% more expensive.
- Higher variable and personnel costs contributed significantly to the increased cost of DSA.
- Common costs were minimal (€5.62) in comparison to differential costs.
Conclusions:
- Intra-arterial DSA is more expensive than MRA due to higher supply and personnel costs, largely driven by longer procedure times.
- The study's cost analysis is limited to the radiology department; hospitalisation costs for DSA would further increase its overall expense.
- MRA presents a lower-cost, non-invasive, and safer alternative to DSA for evaluating lower extremity arterial disease, supported by its diagnostic accuracy and favorable biological profile.
Purpose:
The aim of this study was to analyse the costs pertaining to the radiology department of magnetic resonance angiography (MRA) and intra-arterial digital subtraction angiography (DSA) in the evaluation of arterial disease of the lower limbs.
Materials And Methods:
The differential cost of the two procedures, i.e. the sum of equipment costs (amortisation and service contract), variable costs (supplies and related services) and personnel costs (radiologist, radiographer and nurse) was determined. The common cost (auxiliary personnel and indirect internal costs) was also calculated. Finally, the full cost of the two procedures was obtained (sum of differential and common costs).
Results:
The differential cost of MRA was 186.14 euro (equipment costs: 50.80 euro, variable costs: 75.04 euro, personnel costs: 60.30 euro) while the differential cost of intra-arterial DSA was 238.18 euro (equipment costs: 57.60 euro, variable costs: 90.13 euro, staff costs: 90.45 euro). The estimated common cost was 5.62 euro. Therefore, the full cost of MRA was 191.76 euro and the full cost of intra-arterial DSA was 243.80 euro (27.1% higher).
Discussion And Conclusions:
Intra-arterial DSA costs more than MRA, mainly because of the higher costs of supplies used during the procedure and higher personnel costs (as a result of the longer duration of intra-arterial DSA). It should be noted that our evaluation considers costs pertaining to the radiology department only. It is evident that an economic analysis considering hospital costs as well would result in much higher costs for DSA if post-procedure hospitalisation is required. Our results cannot be simply exported to other radiology departments since they refer to the technology and organisation adopted in our department. However, our cost analysis model can be easily applied to other environments. MRA provides good diagnostic accuracy in the evaluation of arteries of the lower extremities, and its biological cost is far lower than that of intra-arterial DSA (MRA is noninvasive, it does not use ionising radiation, and the contrast medium is safe). Its lower cost is another argument in favour of the use of MRA instead of intra-arterial DSA in the evaluation of lower-extremity arterial disease.
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