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Economic analysis of bedside ultrasonography (US) implementation in an Internal Medicine department

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Abstract

The economic crisis, the growing healthcare demand, and Defensive Medicine wastefulness, strongly recommend the restructuring of the entire medical network. New health technology, such as bedside ultrasonography, might successfully integrate the clinical approach optimizing the use of limited resources, especially in a person-oriented vision of medicine. Bedside ultrasonography is a safe and reliable technique, with worldwide expanding employment in various clinical settings, being considered as “the stethoscope of the 21st century”. However, at present, bedside ultrasonography lacks economic analysis. We performed a Cost–Benefit Analysis “ex ante”, with a break-even point computing, of bedside ultrasonography implementation in an Internal Medicine department in the mid-term. Number and kind estimation of bedside ultrasonographic studies were obtained by a retrospective study, whose data results were applied to the next 3-year period (foresight study). All 1980 foreseen bedside examinations, with prevailing multiorgan ultrasonographic studies, were considered to calculate direct and indirect costs, while specific and generic revenues were considered only after the first semester. Physician professional training, equipment purchase and working time represented the main fixed and variable cost items. DRG increase/appropriateness, hospitalization stay shortening and reduction of traditional ultrasonography examination requests mainly impacted on calculated revenues. The break-even point, i.e. the volume of activity at which revenues exactly equal total incurred costs, was calculated to be 734 US examinations, corresponding to € 81,998 and the time considered necessary to reach it resulting 406 days. Our economic analysis clearly shows that bedside ultrasonography implementation in clinical daily management of an Internal Medicine department can produce consistent savings, or economic profit according to managerial choices (i.e., considering public or private targets), other than evident medical benefits.

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Abbreviations

ACEP:

American College of Emergency Physicians

AIOP:

Italian Private Healthcare Association

CBA:

Cost-Benefit Analysis

BEA:

Break-Even Analysis

BEP:

Break-Even Point

CCNL:

National Collective Labour Agreement

CT:

Computed Tomography

CVP:

Cost–Volume–Profit (analysis)

ED:

Emergency Department

DRG:

Diagnosis-Related Groups

HTA:

Health Technology Assessment

ICU:

Intensive Care Unit

IM:

Internal Medicine

NHS:

National Healthcare Service

SAEM:

Society for Academic Emergency Medicine

SIMEU:

Italian Emergency Medicine Society

SIMI:

Italian Internal Medicine Society

US:

Ultrasonography

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Correspondence to Americo Testa.

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All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the author.

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Testa, A., Francesconi, A., Giannuzzi, R. et al. Economic analysis of bedside ultrasonography (US) implementation in an Internal Medicine department. Intern Emerg Med 10, 1015–1024 (2015). https://doi.org/10.1007/s11739-015-1320-7

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