A clinical service line investment recovery framework for medical equipment: method specification and a retrospective...

Hospitals may not preserve the assumptions approved for medical-equipment purchases alongside post-adoption financial and value outcomes. We specified a clinical service line (CSL) investment recovery framework and examined its initial feasibility using routine hospital records.

Targeted mapping of health technology assessment (HTA), lifecycle HTA, management accounting, and organizational learning concepts was followed by internal logic checks. A retrospective records-based application was conducted for one purposively selected 4 K arthroscopy camera-head investment at a Japanese acute-care hospital. Aggregate fixed-asset, lease, and claims records were analyzed descriptively without patient-level data or causal attribution.

The framework links CSL definition, pre-adoption commitments, annualized investment burden (AIB), contribution margin (CM), evidence status, allocation, value guardrails, and feedback. The 72-month lease had a total value of JPY 4,728,240 and a minimum documented annual burden of JPY 788,040. Shoulder arthroscopy volume increased from 220 to 245 procedures (11.4 percent), and nominal procedure-fee revenue increased from JPY 102.8 million to JPY 114.9 million (11.8 percent) between 12-month periods. Planned values, variable costs, direct use logs, and prespecified quality or access indicators were unavailable; CM-based recovery metrics could not be calculated. The documented annual burden equaled JPY 31,522 per observed additional procedure, or 6.52 percent of the observed revenue increase under full attribution.

The framework operationalizes hospital-level post-adoption and lifecycle HTA as an auditable CSL process. The application demonstrated partial data availability and identified fields that must be preserved prospectively; it did not establish causality, actual recovery, acceptability, or decision impact.