Cost Analysis of PET and Comprehensive Lifestyle Modification for the Reversal of Atherosclerosis

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FIGURE 1.
Care pathway in Century Trial intervention.
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FIGURE 2.
General approaches followed in Century Trial.

TABLE 1

Resources and Procedures Involved in Representative Patient Visit

				Follow-up
				Intervention group			Control group
Procedure group	Resource	Procedure	Baseline	Months 1, 2, 4, 8, 18, 30, 42, 54	Years 1, 3, 4	Years 2, 5	Years 1, 3, 4	Years 2, 5
Nurse assessment	One registered nurse	Assessment of physical activity	X	X	X	X	X	X
		Recording of medications	X	X	X	X	X	X
		Monitoring of events		X	X	X	X	X
PET scan	One nuclear technician	12-lead electrocardiography	X	Not required	Not required	X	Not required	X
		PET	X			X		X
	One cardiologist	Labs, routine	X			X		X
		Labs for future analysis	X			X		X
Treadmill	One registered nurse	Exercise stress test	X	Not required	X	X	Not required	X
	One cardiologist		X		X	X		X
Diet consult	One dietician	Diet assessment	X	X	X	X	X	X
		Diet consult		X	X	X
Physician consult	One cardiologist	Physician consult	X	X	X	X

TABLE 2

Average Hours of Resource Time Spent per Patient Visit Type (n = 12 Patient Visits)

			Follow-up
			Intervention group				Control group
Procedure group	Resource	Baseline	Months 1, 2, 4, 8, 18, 30, 42, 54	Years 1, 3, 4	Years 2, 5	All visits^*	Years 1, 3, 4	Years 2, 5	All visits^†
Nurse assessment	One registered nurse	0.60	0.44	0.33	0.50	6.13	0.37	0.37	2.43
PET scan	One nuclear technician	1.22	Not required	Not required	1.23	3.68	Not required	1.53	4.27
	One cardiologist	0.22			0.25	0.72		0.27	0.75
Treadmill	One registered nurse	1.17	Not required	0.67	0.47	4.10	Not required	0.77	2.70
	One cardiologist	0.38		0.33	0.22	1.82		0.31	1.01
Diet consult^‡	One dietician	0.91	0.37	0.74	0.82	7.71	0.45	0.12	2.49
Physician consult	One cardiologist	0.50	0.26	0.25	0.33	3.98	0.13	0.13	1.17
Total hours per visit		4.99	1.07	2.33	3.82		0.95	3.49
Number of visits per patient for duration of intervention		1	8	3	2		3	2
Total accumulated hours per visit per patient		4.99	8.53	6.98	7.64	28.14	2.85	6.98	14.82

↵* Includes 1 baseline visit; 8 visits for months 1, 2, 4, 8, 18, 30, 42, and 54; 2 visits for years 2 and 5; and 3 visits for years 1, 3, and 4.
↵† Includes 1 baseline visit; 2 visits for years 2 and 5; and 3 visits for years 1, 3, and 4.
↵‡ Diet consult time includes 9% factor to account for remote patient support.

TABLE 3

Estimates of Direct Resource Time and Personnel Time Cost per Patient Visit Type and for All Visits

				Follow-up
					Intervention group		Control group
								All visits^†				All visits^‡
Procedure group	Resource	Number of resources used	Estimated hourly cost^*	Baseline	Months 1, 2, 4, 8, 18, 30, 42, 54	Years 1, 3, 4	Years 2, 5	Amount	%	Years 1, 3, 4	Years 2, 5	Amount	%
Nurse assessment	One RN	1.00	$61.01	$36.60	$26.94	$20.34	$30.50	$374.17	17%	$22.37	$22.37	$148.45	13%
PET scan	Nuclear technician	1.00	$56.21	$68.39	Not required	Not required	$69.32	$207.04	14%	Not required	$85.87	$240.14	31%
	One cardiologist	1.00	$145.81	$31.59			$36.45	$104.50			$38.88	$109.36
Treadmill	One RN	1.00	$61.01	$71.17	Not required	$40.67	$28.47	$250.13	24%	Not required	$46.77	$164.72	28%
	One cardiologist	1.00	$145.81	$55.89		$48.60	$31.59	$264.89			$45.36	$146.62
Diet consult	One dietician	1.00	$52.93	$48.08	$19.41	$39.42	$43.27	$408.15	19%	$23.82	$6.18	$131.88	12%
Physician consult	One cardiologist	1.00	$145.81	$72.90	$37.67	$36.45	$48.60	$580.81	27%	$19.44	$19.44	$170.11	15%
Total cost per visit				$384.63	$84.02	$185.49	$288.21			$65.63	$264.88
Number of visits per patient				1	8	3	2			3	2
Total patient visit cost per patient				$384.63	$672.16	$556.46	$576.43	$2,189.68	100%	$197	$530	$1,111	100%

↵* Based on annual salary plus benefits and 2,000 h per year at 85% efficiency.
↵† Includes 1 baseline visit; 8 visits for months 1, 2, 4, 8, 18, 30, 42, and 54; 2 visits for years 2 and 5; and 3 visits for years 1, 3, and 4.
↵‡ Includes 1 baseline visit; 2 visits for years 2 and 5; and 3 visits for years 1, 3, and 4.

TABLE 4

Five-Year Total Cost Estimates, Assuming 1,300 Patients per Year Divided into 2 Study Groups

	Baseline		Follow-up visits
Line item	Total	% of total	Year 1	Year 2	Year 3	Year 4	Year 5
Variable costs
Intervention group
Time (650 patients/y)^*	$250,012	12%	$339,017	$241,952	$175,178	$175,178	$241,952
Operation expenses	$300,095	14%	0	$300,095	0	0	$300,095
Control group
Time (650 patients/y)^*	$250,012	12%	$42,659	$172,170	$42,659	$42,659	$172,170
Operation expenses	$300,095	14%	0	$300,095	0	0	$300,095
Subtotal variable costs	$1,100,213	52%	$381,675	$1,014,311	$217,837	$217,837	$1,014,311
Fixed costs
Salaries
Management	$66,272	3%	$66,272	$66,272	$66,272	$66,272	$66,272
Finance and information technology support	$160,609	8%	$160,609	$160,609	$160,609	$160,609	$160,609
Patient recruitment	$177,896	8%	$177,896	$177,896	$177,896	$177,896	$177,896
PET scan operation and maintenance	$205,911	10%	$205,911	$205,911	$205,911	$205,911	$205,911
Promotional materials	$15,000	1%	$15,000	$15,000	$15,000	$15,000	$15,000
Office supplies	$2,500	0%	$2,500	$2,500	$2,500	$2,500	$2,500
Floor space and utilities^†	$125,638	6%	$125,638	$125,638	$125,638	$125,638	$125,638
Amortization^‡	$244,477	12%	$244,477	$244,477	$244,477	$244,477	$244,477
Subtotal fixed costs	$998,303	48%	$998,303	$998,303	$998,303	$998,303	$998,303
Grand total	$2,098,515	100%	$1,379,978	$2,012,614	$1,216,140	$1,216,140	$2,012,614
Discounted total costs (PV)	$9,175,759
Discounted total cost/patient (PV)	$7,058.28

↵* Assumes combined total of 1,300 patients per year.
↵† Estimated as 20% of all fixed costs excluding amortization.
↵‡ Allocation based on proportion of Century Trial patients to nontrial patients (65%–35%).
PV = present value.
Discount rate is 3.5%.

TABLE 5

Discounted Total and Per-Patient Costs for Varying Patient Numbers and Discount Rates