Abstract
Background
Pediatric ultrasound (US) guided percutaneous liver biopsy is a commonly performed procedure in children, and may be performed in a variety of clinical settings. However, there is little research on the relative costs associated with different sedation methods and locations.
Objective
This study uses time driven activity based costing (TDABC) to identify relevant costs associated with different biopsy sedation techniques and locations to help inform providers and patients as well as guide value-conscious care. This study analyzes the direct costs associated with pediatric liver biopsy performed in an OR versus a dedicated pediatric sedation clinic.
Materials Methods
A single center retrospective review including data from 111 consecutive procedures completed between June 2021 and April 2024 was performed. Exclusions for procedures included multiple procedures being completed (N = 16) and lack of adequate time stamps for analysis (N = 3). Direct costs were calculated using cost capacity rates (CCR) and TDABC methodology. Propensity score matching between procedures performed in sedation clinic versus OR was performed adjusting for age, gender, ASA status, and inpatient status, and subsequent matches were analyzed via paired t-test in SPSS. All procedures achieved technical success and no procedures resulted in complications.
Results
A total of 111 preliminary procedures including male (N = 55) and female (N = 56) pediatric patients undergoing liver biopsy in an OR (N = 71) or sedation clinic (N = 40) were found and considered for analysis (mean age = 9.13, SD = 6.69). A technical success rate of 100% and a complication rate of 0% was observed. Procedures were then propensity score matched between the OR (N = 32) and sedation clinic (N = 32) for a total of N = 64 matched procedures. Notably, pre-procedure times in the sedation clinic were shorter in duration than pre-procedure times in the OR (p < .001). Total procedure times were also shorter in duration in the sedation clinic than the OR (p = .03). In addition, procedures completed in the OR utilized additional anesthesia staff for an average of 71 minutes, contributing to overall cost. The average total direct costs for matched liver biopsy procedures were $353.82 (SD = 129.02) in the sedation clinic and $565.02 (SD = 228.85) in the OR (p < .001).
Conclusions
In this single center retrospective review, liver biopsies completed in the sedation clinic were associated with significantly lower direct costs, and were not associated with higher complication rates. These findings provide evidence for promoting pediatric sedation clinics as a safe and cost-effective location to perform liver biopsies in appropriate patients. Findings also support the need for more research in TDABC cost analysis, and better understanding of the factors that lead to differences in healthcare costs.