Pediatric Outpatient Noncontrast Brain MRI: A Time-Driven Activity-Based Costing Analysis at Three U.S. Hospitals

Findings from an accepted manuscript published in ARRS’ American Journal of Roentgenology (AJR) have highlighted potentially substantial cost savings by reducing the use of sedation for pediatric brain MRI examinations.

“The health system cost of performing a sedated MRI was substantially greater than that of performing a nonsedated MRI,” writes first author Shireen E. Hayatghaibi, PhD, a health services researcher from the department of radiology at Cincinnati Children’s Hospital Medical Center. “However, the cost of each individual examination type did not vary substantially among hospitals.”

In this AJR accepted manuscript, Hayatghaibi and her study coauthors calculated direct pricing for outpatient noncontrast brain MRI examinations at three academic pediatric hospitals. Labeling MRI examinations as sedated, nonsedated, or limited, process maps were then drawn to describe patient workflows, based on input from key personnel and direct observation. 

Capacity cost rates were calculated for resource types within three categories: labor, equipment, and space (supply cost was calculated separately). The cost of each process step was determined by multiplying step-specific capacity costs by the time required for each step. Costs of all steps were summed to yield a base case total examination cost.

Ultimately, across three free-standing pediatric institutions, the base case cost for a sedated noncontrast outpatient brain MRI was $842 ($775-924 across hospitals), for a nonsedated MRI was $262 ($240-285), and for limited MRI was $135 ($127-141). For all examination types, the largest cost category, as well as the biggest source of difference in cost between hospitals, was labor. Additional sensitivity analysis found that the greatest influence on overall cost at each hospital was the duration of the MRI acquisition.

“Health systems operating within alternative payment models can use this comparative cost information for purposes of cost reduction efforts and establishment of bundled prices,” the authors of this AJR accepted manuscript add.