Economic Evaluation of Home Chest Radiography for Patients With Limited Mobility in Greece: A Modeled Cost-Minimization Analysis From a Limited Societal Perspective.

Introduction Home radiography is an alternative diagnostic pathway for patients with limited mobility who would otherwise need to be transported to a hospital facility for chest radiography. Transporting these patients entails costs, attendant time, and organizational burden. The purpose of the present study was to compare the cost of two-view home chest radiography (frontal and lateral views) with that of the hospital pathway through a public hospital Emergency Department (ED) in clinically stable patients who do not require urgent medical assessment and who, in the absence of a home service, would be transferred to the hospital solely for the examination. The primary economic outcome was the difference in cost per completed diagnostic episode. Methods A modeled cost-minimization analysis (CMA) was conducted from a limited societal perspective that included examination costs, transportation costs, and the opportunity cost of attendant time. Two pathways were compared: home two-view chest radiography and hospital two-view chest radiography after patient transfer via a public hospital ED, modeled narrowly as a transport-and-radiography pathway rather than a full emergency assessment. The analysis assumed a completed diagnostic-quality examination with a radiologist report in the base case. Publicly advertised Greek home-radiography prices were re-evaluated using explicit comparability criteria, Greek ED time data were incorporated in scenario analyses, and a conservative scenario/threshold analysis evaluated technically unsuccessful home examinations followed by the full hospital pathway. Results In the base-case scenario from the limited societal perspective, the cost of the home pathway was estimated at €112.66, while the cost of the hospital pathway was estimated at €135.45. Home radiography was €22.79 less expensive per diagnostic episode. The expanded home-radiography price dataset included 11 observations, with a median of €110, an interquartile range of €100-€120, and an observed range of €50-€140. Greek-informed hospital-time scenarios remained in favor of the home pathway, including a conservative two-hour hospital-attendant-time scenario (incremental cost: 6.07). In a stress test in which a technically unsuccessful home examination was followed by the full hospital pathway, the cost-neutral failure/referral probability was approximately 16.8%. Conclusions Under the assumptions of the model, home two-view chest radiography may be a cost-saving alternative for appropriately selected, clinically stable patients with limited mobility in Greece when transportation costs and the economic value of attendant time are taken into account. The findings are exploratory and model-dependent; they support further prospective evaluation using Greek patient-level resource-use and pathway data.