The capital cost and productivity of MRI in a Belgian setting.

Against the Belgian background of national planning of MRI units and a detailed reimbursement scheme, a study was undertaken to investigate the cost and productivity of MRI units in different investment scenarios and for various operational schedules. This article focuses on capital costs, not operating cost. Using data from a hospital survey and manufacturers, total capital costs per examination were simulated. The survey revealed considerable variation in operational hours, with on average 66 hours per week, resulting in 6 300 examinations per year per unit. Whilst operational hours remained approximately unchanged over the last 8 years, the number of examinations per unit grew by on average 6% per year. Correspondingly, average examination time declined from 45 to 31 minutes. The findings suggest that, mainly due to the increased productivity, capital costs per examination decreased considerably in the examined period. In 2008, the average capital cost per examination is estimated to vary from 23 Euros to 45 Euros for 1.5 Tesla units and from 32 Euros to 62 Euros for 3 Tesla units, assuming an equal examination speed for both types of units.

Assessment of high intensity focused ultrasound for the treatment of prostate cancer.

The optimal treatment for localized prostate tumours remains unknown. The standard curative options (radical prostatectomy and radiotherapy) are not free of significant complications and risks. High-intensity focused ultrasound (HIFU) appears to be an alternative. It is currently used as primary treatment for patients with localized prostate cancer T(1-2) N(0-x) M0, mostly low and intermediate risk, not suitable for surgery and as salvage treatment for locally proven recurrence of prostate cancer after curative therapy. In Belgium, it is estimated that about 730 patients (0.8% of all new prostate cancer patients) were treated with this new technology at 4 hospitals in the years 2000 to 2008. Given the increasing use of HIFU, this study was conducted to assess the current evidence supporting the effectiveness and safety of HIFU and to examine its role in the management of prostate cancer. A standard literature review showed that there is currently not sufficient evidence to support routine use of this new treatment modality. In order to obtain FDA approval, two multicentric non-randomized controlled trials comparing HIFU with cryotherapy and brachytherapy have been started in the U.S. and are now recruiting patients. Until more evidence becomes available, KCE recommends to limit the use of HIFU treatment to study setting. Future research is recommended in the form of comparative studies, preferably randomized controlled trials.