Calculation of Operating Expenses for Conventional Transarterial Chemoembolization in an Academic Medical Center: A Step toward Defining the Value of Transarterial Chemoembolization

Purpose: To determine the "real cost" of conventional transarterial chemoembolization in the treatment of patients with unresectable hepatocellular carcinoma (HCC). Materials and Methods: Comprehensive cost data for performance of conventional transarterial chemoembolization were calculated from a retrospective review of records of 50 consecutive outpatient transarterial chemoembolization procedures in 36 patients with HCC. Costs included labor, equipment, facility acquisition and maintenance, overhead, and administrative costs in a single academic medical center. Hourly rate operational costs for the angiography suite and recovery area were calculated, to which the consumable supply costs were added. Conventional transarterial chemoembolization was defined as selective intrahepatic administration of chemotherapeutic agents (doxorubicin and mitomycin C) emulsified in ethiodized oil (Lipiodol). Results: The hourly rate to operate an angiography suite at the institution was calculated to be $539/h. Recovery time was calculated at $108/h. Median overall cost of conventional transarterial chemoembolization was $3,269 (range, $2,223-$5,654). This overall cost comprised median room and personnel costs of $763 (range, $404-$1,797), consumable costs of $1,886 (range, $1,134-$4,126), and recovery costs of $378 (range, $162-$864). Conclusions: The largest contribution (62%) to the real cost of outpatient transarterial chemoembolization comes from the expendable equipment used in the procedure. The angiography suite and personnel costs constitute 25% a the total, and recovery costs constitute 13%. This finding is a change from previous reports in which angiography suite operation was the greatest contributor to cost. Understanding real cost is an essential step in determining the value of the procedure.