Calculation of operating expenses for conventional transarterial chemoembolization in an academic medical center: a step toward defining the value of transarterial chemoembolization.

PURPOSE: To determine the "real cost" of conventional transarterial chemoembolization in the treatment of patients with unresectable hepatocellular carcinoma (HCC). MATERIALS AND METHODS: Comprehensive cost data for performance of conventional transarterial chemoembolization were calculated from a retrospective review of records of 50 consecutive outpatient transarterial chemoembolization procedures in 36 patients with HCC. Costs included labor, equipment, facility acquisition and maintenance, overhead, and administrative costs in a single academic medical center. Hourly rate operational costs for the angiography suite and recovery area were calculated, to which the consumable supply costs were added. Conventional transarterial chemoembolization was defined as selective intrahepatic administration of chemotherapeutic agents (doxorubicin and mitomycin C) emulsified in ethiodized oil (Lipiodol). RESULTS: The hourly rate to operate an angiography suite at the institution was calculated to be $539/h. Recovery time was calculated at $108/h. Median overall cost of conventional transarterial chemoembolization was $3,269 (range, $2,223-$5,654). This overall cost comprised median room and personnel costs of $763 (range, $404-$1,797), consumable costs of $1,886 (range, $1,134-$4,126), and recovery costs of $378 (range, $162-$864). CONCLUSIONS: The largest contribution (62%) to the real cost of outpatient transarterial chemoembolization comes from the expendable equipment used in the procedure. The angiography suite and personnel costs constitute 25% of the total, and recovery costs constitute 13%. This finding is a change from previous reports in which angiography suite operation was the greatest contributor to cost. Understanding real cost is an essential step in determining the value of the procedure.

The interventional radiology business plan.

Strategic planning and business planning are processes commonly employed by organizations that exist in competitive environments. Although it is difficult to prove a causal relationship between formal strategic/business planning and positive organizational performance, there is broad agreement that formal strategic and business plans are components of successful organizations. The various elements of strategic plans and business plans are not common in the vernacular of practicing physicians. As health care becomes more competitive, familiarity with these tools may grow in importance. Herein we provide an overview of formal strategic and business planning, and offer a roadmap for an interventional radiology-specific plan that may be useful for organizations confronting competitive and financial threats.

A concise history of central venous access.

Central venous access has become a mainstay of modern interventional radiology practice. Its history has paralleled and enabled many current medical therapies. This short overview provides an interesting historical perspective of these increasingly common interventional procedures.

Principles of non-tunneled central venous access.

Non-tunneled central venous access has become an important tool in the management of the sick patient, particularly in the intensive care unit. Image guidance allows more precise placement of lines with overall lower complication rates compared with guidance by physical landmarks. The use of image guidance has brought a procedure traditionally performed by surgeons into the realm of the interventional radiologist. Techniques for placement of non-tunneled central venous catheters, hemodialysis catheters, and peripherally inserted central catheter lines will be discussed.

Management of pulmonary arteriovenous malformations.

Pulmonary arteriovenous malformations are rare lesions with significant clinical complications. These lesions are commonly seen in patients with hereditary hemorrhagic telangiectasia (formerly Osler-Weber-Rendu syndrome). Interventional radiologists are a key part of the treatment team in this complex disease, and a thorough understanding of the disease process is critical to providing good patient care. In this article, the authors review the disease course and its association with hereditary hemorrhagic telangiectasia, discusses the clinical evaluation and treatment of these complex patients, and outlines complications and follow-up.