從傳統X光底片運作迅速轉置到全院性醫療影像擷取傳輸系統之差異成本分析

Abstract

目的：醫療影像擷取傳輸系統(Picture Archiving and Communication System, PACS) 能提升醫療工作的效率，加速病患的處置，是醫療機構走向病歷電子化重要的ㄧ環，但因造價昂貴，使醫療院所裹足不前。本研究探討在一個區域教學醫院實際建置PACS與傳統X光底片運作的差異成本分析。 方法：PACS的購置價格與未來八年的運作成本，與傳統X光底片運作所需成本做比較。 當影像以數位化成像後就不再使用Ｘ光片，以現值法計算兩種作業模式的財務影響。PACS的主要成本項目分別做敏感度分析。回收年限以兩種作業模式每年累計支出的現值推算。 結果：兩種方案比較後PACS 較傳統X光底片運作能節省經費。在敏感度分析上，檢查數量的增加率對傳統X光底片運作的支出有加成效果，當年增率為-6.5%時，PACS將無法節省經費。當數位呈像相關儀器佔PACS初始建置費用的40%，當其購買價格為原來的2.2倍時，兩種方式達平衡。與電腦相關的硬體耐用年限約四年，將在第五年更新，對每年的現值產生一定程度的影響。依據我們的姑算，實施PACS的回收年限是四年。 結論：根據本研究，一個設計適當的PACS相較於傳統X光底片運作，可以節省支出。在有意願走向無片化之醫院，本研究基於差異成本分析提供策略上的支持。

PURPOSE: To determine the differential cost between film-based radiology and a whole scale hospital-wide picture archiving and communication system (PACS) set up at a municipal hospital. MATERIALS AND METHODS: The cash flow and running costs of PACS and film-based operation were measured in an 8-year time horizon. When hospital-wide PACS was implemented in a short duration, no concomitant film output after digitization of images. The net present values (NPVs) for differences between these 2 operations were calculated to show the financial impact. Cost drives for PACS operation were also evaluated by using sensitivity analysis. The duration of return-on-investment (ROI) was measured. RESULTS: As compared with film-based operation, there is net savings for PACS operation during the 8-year time horizon. The duration of ROI is less than 4 years. The saving is mainly from reduction in film-related variable costs. For PACS operation, the CR related devices comprise 40% of the initial capital expenditure. The incremental rate of examination number has exponential effect on the costs for film-based operation, but little effect on those for PACS operation. When there is a -6.5% annual changing rate in examination number, the NPV will become negative. When the initial capital expenditure reaches 2.2 folds of purchasing prices, the NPV will break even. CONCLUSION: Based on our experience, properly designed PACS can produce cost saving as compared with film-based operation under NPV analysis. For hospitals with intension to go filmless, this study offers substantial evidence to support PACS implementation base on differential cost analysis.