Cost Effectiveness Analysis of Protocol Driven Intravenous Urogram Performed by Radiographers

WH Ng, PSF Lee, HCA Chan, H Chun

Hong Kong J Radiol 2003;6:86-9

Aim: To assess the cost-effectiveness of protocol driven intravenous urogram performed by radiographers compared with that performed with a radiologist overseeing the whole examination (non-protocol driven intravenous urogram).

Patients and Methods: 200 patients were randomly selected between December 2001 to August 2002 to receive protocol driven intravenous urogram (100) or non-protocol driven intravenous urogram (100). The number of contrast extravasations, contrast reactions, and total time for the examination were recorded. The number of films, the volume of contrast, and the number of staff for each group were included in the estimation of the cost of the examination.

Results: No significant difference was found in commitment of the final reports for the two methods. Eighty eight percent of protocol-driven intravenous urogram examinations resulted in a diagnosis. Protocol driven intravenous urogram and non-protocol driven intravenous urogram partially answered or failed to answer the clinical question for 12% and 13% of patients, respectively. Only 4% of protocol driven intravenous urograms (4 patients) were sub-optimal and related to insufficient views for examination. There was no statistically significant difference in consumption, volume of contrast, and time taken for the examination. There was a significant difference in the consumption of films — on average 2 additional films were used for the protocol driven intravenous urogram examination. The manpower demand for intravenous urogram examination decreased by 40%. The productivity of intravenous urogram examination could increase by 67%. The estimated cost of an intravenous urogram examination decreased by 27%.

Conclusion: The productivity and efficiency of protocol driven intravenous urogram has significantly improved while the cost of intravenous urogram examination has significantly decreased without degradation of quality. A more extensive utilisation of protocol driven intravenous urogram is therefore advocated.