Why do cost-benefit studies of PACS disagree?

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Abstract
Once the technical difficulties of PACS have been solved, the main obstacle for its introductionwill be its costs. Even though PACS is still under development, it is clear that the equipment for PACS will be much more expensive than the equipment used in the conventional situation. PACS may, however, pay itself back by allowing savings of film, space and personnel. The conclusions of some recent cost-benefit studies disagree on the costs and benefits of PACS. Some conclude that PACS would pay for itself, whereas according to others PACS would be (much) more expensive. We analyzed the latest cost-benefit studies, to find out why their outcomes diverge. The comparison of the results revealed striking differences. The calculations of the annual costs of a hospital wide PACS varied between 2 and 4 million dollars. These differences could not be explained by differences in the size of the hospitals, as indicated by the number of examinations. They were, in part, caused by the fact that the costs per piece of equipment, material or space varied per study. For instance the costs of 1 square foot of (archive) space varied from $10 to $140 per year. The variation in the given costs of the film based system, depended on the fact whether the time spent by medical personnel on film management was taken into account. The differences among these studies demonstrate clearly the need for uniform, well-defined criteria for the calculation of the costs and savings of PACS.
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