Digital diagnostic imaging with a comprehensive PACS: hypothetical economic evaluation at a large community hospital

Since 1983, the 422-bed Victoria General Hospital (VGH) and Siemens Electric Limited have been piloting the implementation of digital medical imaging, including digital acquisition of diagnostic images, in British Columbia. Although full PACS is not yet in place at VGH, experience to date has been used to project annual cost figures (including capital replacement) for a fully digital department. The resulting economic evaluation has been labeled hypothetical to emphasize that some key cost components were estimated rather than observed; this paper presents updated cost figures based on recent revisions to proposed departmental equipment configuration. Compared with conventional diagnostic imaging, digital imaging appears to raise overall annual costs at VGH by nearly $0.7 million, (Canadian currency) or 11.6%; this is more favorable than the previous results, which indicated extra annual costs of $1 million (16.9%). Sensitivity analysis still indicates that all reasonable changes in the underlying assumptions result in higher costs for digital imaging than for conventional imaging. Digital imaging appears likely to offer lower radiation exposure to patients, shorter waiting times, and other potential advantages, but as yet the price of obtaining these benefits remains substantial.