Presurgical Hidden Costs: Imaging, Assessment Clinic

Abstract

The diagnosis of abdominal hernias is often made with only physical examination; however, in several cases radiological support is required. Nowadays, diagnostic tools used are mainly represented by Ultrasounds, Computed Tomography, and, in some complex case, Magnetic Resonance. To discuss the real costs of hernia diagnosis, in addition to purely economics features (reimbursement), some aspects must be taken into consideration such as the radiologist time (single operator for US/presence of technician for CT and MR), the possibility of performing a dynamic evaluation (Valsalva maneuver for US and MR or standing for US), and the employment of ionizing radiation (CT). At first evaluation, ultrasounds appear the less expensive diagnostic modality, but the operator dependency makes this diagnostic tool non-standardizable, leading often to further diagnostic tests, such as CT or MR in young patients, and in complex cases, increasing the expense rate. Cost analysis in medicine cannot be limited to an isolated diagnostic moment, but it might be considered an integrated diagnostic–therapeutic pathway, in order to make the most accurate diagnosis and the best treatment.