Forecasting Demand for

CT / MRI / US

April 2007

A. Bouthillier

A. Meleshko

P. Wares

Outline

• Problem

• Scope

• Approach

• Data Collection

• Data Analysis & Results

• Summary

Problem

• Capital Health serves a population of ~ 1M

• High increase in use of Diagnostic Imaging

• Growing waitlist– Public concern – Pressure from physicians, government

• Required:– Demand forecast next 5 years– Factors influencing demand relative impact

Scope

Focus on how factors beyond population growth affect demand for CT, MRI, and US

Factors we examined:1. Changes in market share

2. Latent demand

3. New technologies

4. New treatments

5. Increasing affliction rates

6. Changing behaviours of physicians

Magnetic Resonance Imaging (All Sites)

5

6

7

8

9

10

11

12

2002/03 2003/04 2004/05 2005/06 2006/07 2007/08 2008/09 2009/10 2010/11 2011/12

Graphed by Two-Month Period

Ex

am

s (

'00

0)

Population Based Forecast

Linear Forecast

Historical DataRegression Line

• Collect qualitative & quantitative data

scans completed + change in waitlist monthly demand

• Analyze demand patterns for effect of variables

• Compose forecast, confer with experts

Approach

Data Collection

– Qualitative:• Interviews with Industry Experts• Factors Questionnaire

– Quantitative: • Capital Health statistics• Other research

• Interviews with Industry Experts:

Qualitative Data Collection

1. Changes in market share

2. Supply-induced demand

3. New technologies

4. New treatments

5. Increasing affliction rates

6. Changing behaviours of physicians

• Factor weightings from questionnaires

Quantitative Data Collection

• Capital Health Data– Population-based scan forecast– Waitlist numbers and times (MRI & CT)– Exams completed & patients served– CT & MRI units in Alberta– Patients served by Capital Health from other

regions

Data Analysis & Conclusions

1. Changes in Market Share

2. Supply Induced Demand

3. New Technologies

4. New Treatments

5. Increasing Affliction Rates

6. Changing Physician behaviours

Aspen Health

Beta Analysis

Exam/Patient Ratios

Adoption Rates

Images Courtesy of Alberta Wellness, 2007

Changes in Market Share

Changes in Market Share

• 3 CT’s added (Aspen region)

27.4% decrease of Aspen residents

Percentage of Capital Health CT Exams Provided to Aspen Health Residents (2 Month Periods, Jan 2002 - Jan 2007)

0.0%

1.0%

2.0%

3.0%

4.0%

5.0%

6.0%

7.0%

8.0%

9.0%

10.0%

2002

-01

2002

-02

2002

-03

2002

-04

2002

-05

2002

-06

2003

-01

2003

-02

2003

-03

2003

-04

2003

-05

2003

-06

2004

-01

2004

-02

2004

-03

2004

-04

2004

-05

2004

-06

2005

-01

2005

-02

2005

-03

2005

-04

2005

-05

2005

-06

2006

-01

2006

-02

2006

-03

2006

-04

2006

-05

2006

-06

Time

Pe

rcen

tag

e o

f C

apit

al H

ealt

h C

T E

xam

s

Percentage of CT Exams by 2Month Period

Linear Regression

Feb 2004: Cold Lake and Hinton CTs Installed

Mar 2004: Westlock CT Installed

Supply-Induced Demand

• Wait Time vs. Demand – CT and MRI– Percentage changes– Removal of outliers– Various lags and groupings

MRI - Percent Change in Wait Time and Percent Change in Demand

-100.0%

-80.0%

-60.0%

-40.0%

-20.0%

0.0%

20.0%

40.0%

60.0%

80.0%

100.0%

-50.0% -40.0% -30.0% -20.0% -10.0% 0.0% 10.0% 20.0% 30.0% 40.0% 50.0%

Change in Wait Time (%)

Ch

ang

e in

Dem

and

(%

)

Priority 1

Priority 2

Priority 3

Total

2 & 3

New Technologies

• Exams/patient ratio – Decrease for MRI (1.4 to 1.2)– Increase for CT (1.3 to 1.4)

MRI and CT Exam Per Patient Ratios (Grouped by Quarter)

0.80

0.90

1.00

1.10

1.20

1.30

1.40

1.50

1.60

1.70

1.80

2000

-2

2001

-2

2002

-2

2003

-2

2004

-2

2005

-2

2006

-2

Quarter

Ex

am

s P

er

Pa

tie

nt

MRI Exams Per Patient

CT Exams Per Patients

New Treatments

• Adoption rate of previous procedures

• Number of scans completed as a percentage of total cases diagnosed

• Diagnostic Grouping Code Scan Categories

Cardiac MRI and Cardiac US as a Percentage of Capital Health Heart Disease Diagnoses

y = 0.0149Ln(x) - 0.0213

R2 = 0.5725

0%

10%

20%

30%

40%

50%

2001

-04

2001

-10

2002

-04

2002

-10

2003

-04

2003

-10

2004

-04

2004

-10

2005

-04

2005

-10

2006

-04

2006

-10

2007

-4

2007

-10

2008

-4

2008

-10

Month

Pe

rce

nta

ge

(%

) Cardiac US

Cardiac MRI

0 – 5%20 – 25%

5 – 10%25 – 30%

10 – 15%30 – 35%

15 – 20%35 – 40%

Monthly Average Growth

0 – 5%20 – 25%

5 – 10%25 – 30%

10 – 15%30 – 35%

15 – 20%35 – 40%

Monthly Average Growth

Number of Chest, Abdomen, and Pelvis CT and MRI Exams as a Percentage of Capital Health Respiratory & Gastrointestinal Disease Cases Diagnoses

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

2001

-04

2001

-10

2002

-04

2002

-10

2003

-04

2003

-10

2004

-04

2004

-10

2005

-04

2005

-10

2006

-04

2006

-10

Month

Pe

rce

nta

ge

(%

)

CT Chest, Abdomen, Pelvis

MRI Chest, Abdomen, Pelvis

Forecast

Relative Impact

Factor % Increasing Affliction Rates 40

Changing physician behaviours 25

Supply-Induced Demand 20

New Treatments 15

New Technology 5

Change in Market Shares -5

CT

Factor % Increasing Affliction Rates 40

Supply-Induced Demand 25

Changing physician behaviours 23

New Treatments 10

New Technology 5

Change in Market Shares -3

MRI

Factor % Increasing Affliction Rates 35

Changing physician behaviours 30

New Treatments 25

Supply-Induced Demand 5

New Technology 5

Change in Market Shares 0

US

Summary- Factors besides population growth

leading to demand for CT, MRI, US

- Focus on 6 factors

- Qualitative and Quantitative Data

- Effect of Market Share, Supply-Induced Demand, Adoption Rate

- Relative impact of factors

Questions?