Cost and Benefit Analysis of Surgeon-performed Point of Care Ultrasound (SP-POCUS) supporting decision making in a General Surgery Department

Background: There still is reluctance among surgeons when it comes to using bedside US in their daily clinical practice, except for very specific fields.Generally, the decision-making process relies on imaging techniques (e.g. CT, MRI). This may lead to a latency of execution, and consequently to a delay in decision making.Objectives: The purpose of this study is to assess the economic impact of systematic and routine use of surgeon-performed point-of-care US (SP-POCUS) in the everyday activities of a surgical department, both for urgent and elective cases.Methods: We conducted a cost-benefit analysis comparing the incremental costs and savings of diagnostic strategies based on alternative procedures to bedside US. The dataset refers to 478 SP-POCUS performed at the General Surgery Department of Policlinico San Pietro (Bergamo, Italy) between January 2018 and February 2020.

The alternatives to SP-POCUS were computed tomography (CT), X-ray (RX), magnetic resonance imaging (MRI), and US performed by the Radiologist. Perexam costs, including personnel time expenditure, were calculated.Results: The economic evaluation revealed that the use of SP-POCUS allowed the hospital to generate €355 net savings per patient, mainly from avoided hospitalizations, fewer hospital days and hours of operating room.Extrapolating these results to a wider scenario, in a similar setting they could have represented a potential annual savings of more than €1.1 million for the Regional healthcare system in Lombardy, and more than €5.7 millions for the whole NHS in Italy.Conclusions: We provided evidence that SP-POCUS may generate important costs savings for health care providers, as it represents the most cost-effective initial diagnostic procedure compared to standard alternatives.The wide applicability of SP-POCUS could be obtained at rather negligible costs for investment in staff training.

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