$2.7 million will buy you a lot of things. If you're a Chicago area executive, for instance, it nets you a suburban English-style mansion sitting on 1.7 leafy acres with a pool shaped like the Batman logo-- a real estate curiosity recently unearthed by the Chicago Tribune. If your tastes run more to imported French-German sports cars, you can tool around in the Bugatti Veyron 16.4 Super Sport, which, at a clocked speed of 267 miles per hour, is one of the fastest street-legal cars in the world. (Only 40 were ever made, apparently; so if you don't own one now, you might be out of luck.)

But if you're an academic medical center interested in running cutting-edge imaging studies, $2.7 million is the price tag for something else entirely: a top-of-the-line CT scanner.

A recent examination of CT costs and trends shows scanners are still a major drain on capital equipment budgets, especially at the high end. And new technology that lets doctors reduce radiation dose is helping to buoy costs of the equipment even as it becomes increasingly important to patients who are growing smarter about medical imaging risks.

"[Patients are] definitely asking more questions about dose," Jason Launders, chief medical physicist with ECRI Institute, who conducted the research, told DOTmed News. "They might not know the ins and outs, but they're definitely more knowledgeable."

Cost analysis

Manufacturers are famously tight-lipped about the costs of health care products and services. Contracts with hospitals for different kinds of equipment or supplies, for instance, often come with nondisclosure clauses. But recently, ECRI Institute, a health care research nonprofit, looked at CT pricing and buying patterns by turning to its database of nearly 2,500 hospitals that hire its consulting service, called SELECTPlus market analytics. The results were published this month. (To register to download a copy of the CT report, go here: https://www.ecri.org/ctscan.)

The database works like this: hospitals submit pricing data for stuff they buy or are thinking of buying to ECRI. The group then works with the hospital to make sure they're getting the best deal. "We get 400 prices to analyze a day for critical items, from beds, tables and lights, all the way up to high-end imaging systems. Anything a hospital's buying we consider within the scope of this service," Jen Myers, vice president of SELECTPlus services, told DOTmed News.

Real costs

By looking over its CT data, what ECRI found is that CT scanners, while still hugely expensive, in some ways have become more affordable for providers.

"In real terms, the price of CT has come down," Launders said.

The list price for a midrange, 20 to 64-slice CT scanner now averages $1.2 million, according to ECRI. Launders says, oddly enough, the average list price for most cutting-edge equipment has stayed pretty constant. When 4-slice came out in 1998, it also listed for $1.2 million. And when 16-slice came out in 2004, it listed for $1.2 million too, he said.

Now a 16-slice CT carries a much lower list price, of around $800,000, ECRI said. Plus, the older numbers have not been adjusted for inflation. Once you adjust for inflation, you can see how big the price change has really been. When a 4-slice scanner debuted, it actually cost about $2.3 million in 2010 dollars - in other words, it was in the neighborhood of today's premium scanners.

Services add to the total

List prices are also just that - the prices listed by the company during the initial steps in a transaction. In reality, hospitals rarely pay the full amount. According to information ECRI provided, quoted vendor prices for different models typically average around 50-65 percent of the list price. For premium scanners, for instance, hospitals shell out on average about $1.5 million. It's not cheap, but it's also not $2.7 million.

Still, the vendor prices don't capture one of the big continuing expenses of scanners: service costs. These typically run over $100,000 per year. And the price differential for a premium scanner over a lower-slice scan can be huge. Premium scanners, which can have something like 300 plus detector rows, can run up to $70,000 a year more in service costs than cheaper models, ECRI said. Over the 8-10 year lifetime of the highest-end scanners, a hospital would be looking at an almost an $800,000 difference, according to ECRI's figures.

Service costs are also not falling that fast. Although companies are under pressure from rivals offering multi-vendor services and third-party firms to provide cheaper offerings, the high price of replacement glassware limits their options - it can cost upwards of $200,000 to replace a tube on a premium system outside of a service contract, Launders said.

"The big thing is the glassware; these are very expensive service items," he said.

Still, companies are trying to give buyers more bang for their buck. For instance, Launders said the major manufacturers are offering remote monitoring, so they can notify providers of problems early to swap out tubes before they fail or otherwise minimize downtime. Also, fixing equipment remotely is cheaper than sending in an engineer "every time the phone goes," Launders said.

"There are relatively few CT systems out there compared to other technologies, like cars," Launders said. "Manufacturers can more easily keep track of all their scanners."

Dose reduction

One new feature potentially pumping up costs is a radiation dose reduction technology called iterative reconstruction. This uses algorithms run on super-powerful computers to scrub away noise from CT images so doctors can take the same scans at much lower doses. All four major CT vendors included in ECRI's research have their own versions. GE Healthcare has VEO and ASIR; Philips Medical Systems has iDose4; Siemens Healthcare has SAFIRE and IRIS; and Toshiba Medical Systems has AIDR3D.

According to manufacturer-run studies, these technologies can help cut the dose for some scans between 50 and 80 percent. For now, they're generally only available on higher-end premium systems, although ECRI does note that some vendors are starting to offer them as optional upgrades for some lower-slice systems, even 16-slice ones.

One reason they're more commonly found on higher-end systems is cost, ECRI said. When bought with the system, IR products can raise the price tag by upwards of $200,000. "The higher-end systems generally run higher volumes so they can assume you'll make back part of the costs," Launders notes. Vendors don't have much wiggle room though, as the high cost largely stems from the big, blisteringly fast computers needed to run the programs.

"The computer power they're now putting in CT scanners used to be the reserve of NASA, it's pretty amazing," Launders said.

However, two third-party companies have started offering cheaper iterative reconstruction technologies, typically going for half or a quarter of the manufacturer's price. One company, Israel's Medic Vision, got its system SafeCT cleared by the Food and Drug Administration only a little over a year ago. And Swedish firm Sapheneia's Clarity was released in 2007.

"The advantage of those is you can link any number of CT scanners, new CT scanners, into their software and produce similar results," Launders said.

Still, even if it's costly, the technology is gradually trickling down to lower-end systems, and doctors are starting to demand it more and more.

"It's now becoming an expectation rather than a nice-to-have luxury. That's definitely changing," Launders said.