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101 ESOPHAGOGASTRODUODENOSCOPY (EGD): A MICROCOSTING STUDY EVALUATING PROCEDURAL COSTS IN AN OUTPATIENT ENDOSCOPY CLINIC JC Sambrook1, W Chui1, H Wang1, AR Levy1, RA Enns2, M Choi3, L Lo3, D Chan3 AIMS: Esophagogastroduodenoscopy (EGD) is a procedure that is commonly performed to diagnose a range of upper gastrointestinal disorders. To date, little information is available about the costs of EGD in Canada. Using microcosting methodology, the procedural cost of performing EGD in an outpatient clinic setting was determined in St Paul's Hospital (SPH), a teaching hospital in Vancouver.
1Oxford Outcomes Ltd, Vancouver, British Columbia; 2Department of Gastroenterology, St Paul's Hospital, Vancouver, British Columbia; 3University of Toronto, Toronto, Ontario
METHODS: A 'time-and-motion' study was performed on 100 EGD procedures (18 inpatients and 82 outpatients) performed in the SPH outpatient endoscopy clinic between July and October 2004. We estimated the direct medical costs including: nursing and physician time (in min) spent per EGD episode beginning with patient registration and ending with patient discharge postprocedure; and resources expended, including supplies and medications. We applied unit costs and nursing wages from SPH and provincial physician fees. All values are reported in 2004 Canadian dollars and exclude overhead and indirect costs.
RESULTS: The mean age in this series was 60 years (23; 91). Total time for the EGD procedure was 166 min (38; 316), of which 24 min (13; 43) was the duration of the EGD procedure. Patients spent the largest duration (75 min) in postprocedure observation. The total overall cost was $269 ($46; $1,515). Medications and supplies accounted for $13 ($0; $87) and $157 ($8; $1393) of the total cost, respectively. Labour costs contributed the remaining $91 ($24, $175). Outpatients were more expensive than inpatients ($306 versus $101; P=0.0239) with the principal difference ($133) reflected in supplies consumed during the procedure phase, however, personal costs were also less in inpatients since their recovery time in the GI was decreased over outpatients.
CONCLUSIONS: These costs of diagnostic procedures are accurate estimates of EGD procedures in Canada, are useful for inclusion in studies of the economic consequences of gastrointestinal diseases in Canada.