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Comprehensive computerized medical imaging: interim hypothetical economic evaluation

The 422-bed Victoria General Hospital (VGH) and Siemens Electric Limited have since 1983 been piloting the implementation of comprehensive computerized medical imaging, including digital acquisition of diagnostic images, in British Columbia. Although full PACS is not yet in place at VGH, experience to date habeen used to project annual cost figures (including capital replacement) for a fully-computerized department. The resulting economic evaluation has been labelled hypothetical to emphasize that some key cost components were estimated rather than observed; this paper presents updated cost figures based on recent revisions to proposed departmental equipment configuration which raised the cost of conventional imaging equipment by $0.3 million* and lowered the cost of computerized imaging equipment by $0.8 million. Compared with conventional diagnostic imaging, computerized imaging appears to raise overall annual costs at VGH by nearly $0.7 million, or 11.6%; this is more favourable than the previous results, which indicated extra annual costs of $1 million (16.9%). Sensitivity analysis still indicates that all reasonable changes in the underlying assumptions result in higher costs for computerized imaging than for conventional imaging. Computerized imaging offers lower radiation exposure to patients, shorter waiting times, and other potential advantages, but as yet the price of obtaining these benefits remains substantial.