Cost analysis of different protocols for imaging a patient with acute flank pain

The aim of this study was to analyse the costs of different diagnostic appr oaches to patients with acute flank pain. Four different diagnostic approac hes were considered: (a) spiral CT without contrast medium (CM); (b) plain Nm, ultrasonography (US) and intravenous urography (IVU) - the latter proce dure is used in our department in cases still unsolved following the former investigations (28% in our experience); (c) plain film, US and spiral CT w ithout CM (as an alternative to IVU in 28% of cases); and (d) IVU. The cost of each procedure in a university hospital was calculated, following analy sis of the differential costs of each investigation (equipment, depreciatio n and maintenance costs, related i materials and services, radiologists, ra diographers nurses) and their common costs (auxiliary personnel and indirec t internal costs). Finally, we calculated the full cost of each procedure a nd applied it to the different diagnostic approaches. The full cost of each i approach was: (a) spiral CT without CM = 74 Euro; i (b) plain film, US a nd IVU (28 %) = 66.89 Euro; (c) plain film, US and spiral CT without CM (25 %) = 64.93 Euro; (d) IVU = 80.90 Euro. Intravenous urography alone or in u nsolved cases is not to be considered because it provides higher costs and worse diagnostic results, whereas X-ray dose to patient. is almost equal be -tween IVU and spiral CT, Spiral CT integrated to plain film and US in unso lved cases could be preferred because of lower cost and dose to patient, th ough reaching a diagnostic conclusion may take longer than an immediate spi ral CT.