Table 5.

Reduction in service costs

Study	Country of origin	Advanced practice activity/focus	Service cost assessment	Study conclusions
Brown and Desai, 200238	UK	Radiographer-led barium enema examination	Service cost was calculated as examination time × hourly staff salary costs (midpoint of scales using 2000/2001 salaries). The proportion of all staff costs was summed to determine the total examination cost and establish potential annual savings No consideration was given to examination reporting time, patient pre- or post- examination assistance, costs of using two rooms for radiologist arm; cost of antispasmodics in radiographer arm	No significant difference in mean examination time between radiologist and radiographer Cost of radiologist-performed barium enema £17.87; cost of radiographer-performed barium enema £14.06. Cost saving of 21% Annual potential saving to hospital (assuming 1500 enema examination per year) by employing radiographers to undertake barium enema examinations = £5715
Brealey et al, 200532	UK	Radiographer reporting of appendicular skeletal radiographs	Radiographer reporting costs were based on time taken to report radiographic images plus capital and training costs related with service implementation. These were compared with radiologist costs related to interpreting and dictating report for a radiographic image. Costs were inflated to common year 2001/2002 Radiologist dictation time was used as proxy for secretarial report typing time but was not taken into account within baseline cost model. Radiographers typed own reports Three practice models compared to determine costs; developed to costs related to radiology department only and not to wider hospital economy (e.g. reduction in admissions and bed stays)	Radiographer reporting costs/saving: base case analysis—£361 saving per annum; worst case scenario—£4524 cost per annum; best case scenario—£4528 saving per annum If radiographers had secretarial support for report typing, then cost per radiograph reported would decrease from £0.73 to £0.66
Jones and Robinson, 200839	UK	Consultant radiographer • Leadership • Service change	Service cost equated to number of chest radiograph referrals before and after intervention Cost of 100 chest radiographs = £2100 (£21.00 each) Cost of 100 strips of pH paper = £15.85 (15.85p each) Post introduction of pH paper testing, chest radiography referrals reduced from 120 per month (£2520) to 50 per month (£1050) Cost reduction = £2520 − £1050  + £19.02 (120 pH papers) = £1489.02 per month	“College of radiographers [reference 1 in jones paper] states that a consultant radiographer will initiate service developments and improve patient outcomes by implementing findings of clinical audit and clinical risk assessment” Case study demonstrates success of consultant role in achieving this but evaluation limited to service costs and does not evaluate patient outcomes
Ludwig and Ferrara, 200840	USA	RA role	Procedures undertaken by RA were correlated with the most likely “CPT” code and associated professional component rate Total amount of potential reimbursement was estimated for each RA in training on the basis of the volume of procedures performed multiplied by the participant rate. Total RAs in training = 8 (single academic institution) Number of procedures performed per RA over 1500 clinical hours ranged from 501 to 711 (mean 581, median 536). Potential professional fee reimbursement ranged from $43,484 to $72,613 (mean $58,957, median $58,277)	Reimbursement costs for some examinations include image reporting not undertaken by RA; therefore, reimbursement may be slightly overinflated Actual reimbursement may be higher once RAs are established in workforce Radiologists benefit most from participating in education of RAs, if practice is to employ RA on qualification
Hardy et al, 201333	UK	Radiographer-led immediate reporting service for patients with MSK trauma	For cost-effectiveness analysis, patient health gain was measured in terms of change in utilities derived from EQ-5D™ responses at baseline and 8-week follow-up Resources used and costs of immediate reporting service were analyses at the patient level and compared with standard reporting practice. Measures included patient journey time, admission and recall rates. Standard NHS costs (2009/2010) were used to calculate financial cost of intervention and control arm reporting practice	Using NHS unit costs, whole-episode costs for patients in the intervention arm were on average £23.40 less than for those in the control arm. Cost reduction was associated with a significant reduction in short-stay admissions Potential annual savings to the NHS was calculated to be £117 million (approximately £468,000 per hospital trust) Assuming annual trauma MSK attendance of 20,000 per hospital trust, 5–6 WTE reporting radiographers required to operate extended day reporting service (8 am–2 am) 7 days per week Assuming midpoint band 7 salary scale of £35,184 and 20% on costs, savings to hospital trust after employing additional reporting radiographers to operate service was £214,674
Lockwood, 201635	UK	Radiographer CT head reporting	Economic analysis based on annual number of CT head referrals at a single hospital trust and radiographer reporting of non-complex CT head examinations Modelling for radiologist and radiographer hourly costs was based on Netten et al ready reckoner for NHS staff costs and Unit Costs for Health and Social Care 2014 Three reporting time models (RCR; Department of Health; and CfWI) were compared	Using RCR model, radiographer reporting would reduce cost of reporting activity by between £17 and £34 per patient and using CfWI between £20 and £41 per patient depending on reporting time taken Annual CT head referral data from NHS trust organization did not differentiate complex from non-complex examinations and therefore potential savings per hospital trust quoted (£124,757–£299,359) are likely to be overinflated

CfWI, Centre for Workforce Intelligence; CPT, current procedural technology; MSK, musculoskeletal; NHS, National Health Service; RA, radiologist assistant; RCR, Royal College of Radiologists; WTE, whole time equivalent.