Cost Analysis of Magnetic Resonance Imaging and Computed Tomography in Cardiology: A Case Study of a University Hospital Complex in the Euro Region.

INTRODUCTION: In recent years, several hospitals have incorporated MRI equipment managed directly by their cardiology departments. The aim of our work is to determine the total cost per test of both CT and MRI in the setting of a Cardiology Department of a tertiary hospital. MATERIALS AND METHODS: The process followed for estimating the costs of CT and MRI tests consists of three phases: (1) Identification of the phases of the testing process; (2) Identification of the resources consumed in carrying out the tests; (3) Quantification and assessment of inputs. RESULTS: MRI involves higher personnel (EUR 66.03 vs. EUR 49.17) and equipment (EUR 89.98 vs. EUR 33.73) costs, while CT consumes higher expenditures in consumables (EUR 93.28 vs. EUR 22.95) and overheads (EUR 1.64 vs. EUR 1.55). The total cost of performing each test is higher in MRI (EUR 180.60 vs. EUR 177.73). CONCLUSIONS: We can conclude that the unit cost of each CT and MRI performed in that unit are EUR 177.73 and EUR 180.60, respectively, attributable to consumables in the case of CT and to amortization of equipment and staff time in the case of MRI.

Longer-Term Results of a Universal Electronic Consultation Program at the Cardiology Department of a Galician Healthcare Area.

BACKGROUND: Telemedicine models play a key role in organizing the growing demand for care and healthcare accessibility, but there are no described longer-term results in health care. Our objective is to assess the longer-term results (delay time in care, accessibility, and hospital admissions) of an electronic consultation (e-consultation) outpatient care program. METHODS: Epidemiological and clinical data were obtained from the 41 258 patients referred by primary care to the cardiology department from January 1, 2010, to December 31, 2019. Until 2012, all patients were attended in an in-person consultation (2010-2012). In 2013, we instituted an e-consultation program (2013-2019) for all primary care referrals to cardiologists that preceded patients' in-person consultations when considered. We used an interrupted time series regression approach to investigate the impact of the e-consultation on (1) delay time (days) in care and (2) hospital admissions. We also analyzed (3) total number and referral rate (population-adjusted referred rate) in both periods (in-person consultation and e-consultation), and (4) the accessibility was measured as number of consultations and variation according to distance from municipality and reference hospital. RESULTS: During the e-consultation, the demand increased (7.2±2.4% versus 10.1±4.8% per 1000 inhabitants, P<0.001), and referrals from different areas were equalized. The reduction in delay to consultation during the in-person consultation (-0.96 [95% CI, -0.951 to -0.966], P<0.001) was maintained with e-consultations (-0.064 [95% CI, 0.043-0.085], P<0.001). After the implementation of e-consultation, we observed that the increasing of hospital admission observed in the in-person consultation (incidence rate ratio, 1.011 [95% CI, 1.003-1.018]), was stabilized (incidence rate ratio, 1.000 [95% CI, 0.985-1.015]; P=0.874). CONCLUSIONS: Implementing e-consultations in the outpatient management model may improve accessibility of care for patients furthest from the referral hospital. After e-consultations were implemented, the upward trend of hospital admissions observed during the in-person consultation period was stabilized with a slight downward trend.

[Evaluation of the pilot program of medicine dispensation in customized doses in Galicia [Spain]]. / Evaluación del Programa Piloto de Dispensación de Medicamentos en Dosis Personalizada en Galicia.

OBJECTIVE: To quantify, from an economic perspective, the results of the Pilot Program of Dispensation of Medicines in Unitary Dose in Galicia, Spain. PATIENTS AND METHODS: Retrospective study from 35,923 antibiotic prescriptions in customized doses corresponding to 5 active principles (amoxicillin, amoxicilin/clavulanic, claritromicin, cefuroxima axetil and ciprofloxacin). The program, which worked during 12 months, included 292 physicians from 46 units of primary care of the Galician Health Service and 167 offices of pharmacy. RESULTS: 60.57% of the prescribed treatments did not adjust exactly to the conventional presentations existing in the market. Savings in units of antibiotic of the dispensation in customized doses compared with the conventional one has been of 14.32%. Registered economic saving has been of 29.94%. The inclusion of 2 new presentations in amoxiciline and amoxiciline/clavulanic (of 15 and 21 tablets) and of one in the other 3 (cefuroxime and ciprofloxacin of 14 tablets and clarithromycin of 16) would avoid 86.5% of the leftover units without having to implement individualized dispensation. CONCLUSIONS: An important antibiotic stock is being generated in home medicine cabinets as a result of the leftovers of prescribed treatments that in the case of Galicia are equivalent to more than 1,800,000 doses of antibiotic in 2004. This problem could be reduced with the dispensation in customized dose and partially with new presentations.