Purpose or Case Report: While a definitive conclusion regarding the optimal diagnostic strategy for midgut volvulus remains elusive, value can also be derived from cost. The purpose is to quantify and compare the monetary and time costs, from a provider perspective of imaging with Upper GI (UGI) versus Ultrasound (US) of children with suspected midgut volvulus.
Methods & Materials: Process maps were created by direct patient shadowing, electronic medical record review and interviews with front-line staff. Using the time-driven activity-based costing (TDABC) methodology, practical capacity cost rates were calculated for personnel, equipment, and facility costs. The cost of each process step was determined by multiplying the step-specific capacity costs by the median time required to complete each step. Base case total pathway costs for UGI and US were computed by summing the costs of all steps through each process pathway. Multivariate sensitivity analysis was performed applying all minimum and maximum labor costs. Costs across the modality pathways were then compared.
Results: Base case process maps demonstrated an average time of 77 minutes for the UGI pathway and 53 minutes for the US pathway. UGI pathway time varied based on whether the patient was able to consume contrast or if a nasogastric tube (NG) tube was required. Total pathway time for patients’ undergoing evaluation with UGI was on average 23 minutes longer than those undergoing evaluation with US.

Total base case cost for an UGI evaluation was $223.80 when the procedure was performed by a radiology assistant (RA) and $343.06 when the procedure was performed by a radiologist. Multivariate sensitivity analyses for UGI evaluation applying all minimum and maximum labor cost variables revealed a total range of $198.74 (minimum) to $256.65 (maximum) when the procedure was conducted by an RA and $304.32 (minimum) to $389.58 (maximum) when conducted by a radiologist.

Total base case cost for US evaluation was $149.60 when the procedure was performed by a sonographer and $210.23 when the procedure was performed by a radiologist. Multivariate sensitivity analyses for US evaluation applying all minimum and maximum labor cost variables revealed a total range of $129.36 (minimum) to $181.48 (maximum) when performed by a sonographer and $186.42 (minimum) to $243.49 (maximum) when performed by a radiologist.
Conclusions: Ultrasound is a more efficient and less costly alternative compared to UGI in patients with suspected midgut volvulus.