due to the protocols in our institution as
well as the study design. Ablation probes
are the single dominant factor affecting
the cost of ablation procedures. A procedure that requires more probes will be
more expensive. For a similar sized lesion,
irreversible electroporation requires
more probes than cryoablation, and
cryoablation requires more probes than
microwave or radiofrequency ablations.
There are a few limitations to this
study. In our institution the CT scanner,
procedure room personnel, and interventional radiologist are booked for a fixed
time for all procedures regardless of the
ablation modality, which makes the cost
calculation less sophisticated. However,
the actual time required for procedures
may not necessarily be the same and different institutions may not allot a fixed
time for each procedure. We perform all
ablation procedures with CT scan guidance. There is variability in the imaging
modality used for guidance among interventional radiologists in that some may
use CT for cryoablation and ultrasound
for radiofrequency ablation. We also perform all procedures under general anesthesia. There is no commonly accepted
standard of care regarding anesthesia
and variability exists between different
centers for various ablation procedures.
This study assumes similar types and
rates of complications for the various
ablation techniques, which is true in our
experience but we have not measured
it. Ablation equipment is provided at
no additional charge to our institution.
However, there are various methods of
purchasing ablation equipment. Finally,
this is a single institution study and both
the absolute and relative costs may vary
by institution. The allocation methods
for indirect costs can vary substantially
between institutions.
There are many factors contributing
to the selection of an ablation modal-
ity for the treatment of a tumor. Factors
other than cost including efficacy, risks,
possible complications, tumor location,
type, and size commonly have more
important roles in determining the treat-
ment of choice. Cost can be one of the
more important factors in the utilization
of an ablation modality, assuming that a
lesion can be treated with multiple abla-
tion modalities with similar efficacy.
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Dr. Amin Astani is a senior radiology resident at
the Henry Ford Hospital in Detroit, Michigan. He
obtained his MBA degree from Illinois Institute of
Technology before finishing medical school at the
University of Minnesota. He can be contacted at
amina@rad.hfh.edu.
Manuel L Brown, MD, FACR, is a professor of
radiology at Wayne State University School of
Medicine and the Kovacs Chair of Radiology at
Henry Ford Hospital and Health Network. He is Chair
of the Henry Ford Medical Group Board of Governors
and serves on the Henry Ford Hospital Board of
Trustees and the Henry Ford Health System Board of
Trustees. He is a past president of the American
College of Radiology and was previously a professor
at both the University of Pittsburgh and the
Mayo Clinic.
Kay Steusloff, RN is revenue manager in the
department of radiology at Henry Ford Hospital
in Detroit, Michigan.
Acknowledgment: Special thanks to Dr. Todd Getzen
in Division of Interventional Radiology
for his guidance and to Meredith Mahan, MS,
statistician at the Department of Public Health
Science at the Henry Ford Health System, who
performed the detailed statistical analysis.
