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?