Canine Cushing's Case Files: The ins and outs of detection and treatment-The economics of managing hyperadrenocorticism in dogs (Sponsored by Dechra Veterinary Products)


An underestimated financial benefit exists for any practice that produces satisfied clients who have pets with well-controlled diseases that live longer lives.

Most veterinary practice owners and managers know the amount clients spend per clinic visit and are familiar with the alphabet soup describing such transactions: Average Transaction Fee (ATF), Average Charge per Transaction (ACT), Average Transaction Charge (ATC), Average Doctor Transaction (ADT), and numerous others. These metrics — and their trends over time — reveal the health of your business. On the other hand, practices rarely examine the financial or economic impact of a particular condition or disease. We are trained to think in terms of transactions rather than considering a bigger picture. However, an underestimated financial benefit exists for any practice that produces satisfied clients who have pets with well-controlled diseases that live longer lives. These clients have a renewed trust in and loyalty to the practice and are more likely to return there for their pet's other wellness and medical needs.

Fritz Wood, CPA, CFP

The impact of managing a chronic disease

Consider the impact that management of just one common chronic disease can have on your practice's bottom line. How many canine patients with hyperadrenocorticism did you identify and treat in the last 12 months? What's the incremental gross and net income from treating and monitoring a dog with hyperadrenocorticism in the 12 months after detection, and how much impact does your pricing have on a client's ability and willingness to treat the disease?

Cushing's disease is a chronic illness that is not cured, but rather managed throughout a pet's life. What's the annual financial impact of managing patients with Cushing's syndrome on your practice? What's the long-term benefit to your practice of skillfully managing a dog with Cushing's disease and having the owners happy that their dog's clinical signs have resolved?

A year in the life of Riley

Consider a case example such as Riley,* a 12-year-old spayed female beagle that weighs 27 lb (12.3 kg). Her owners have historically taken good care of riley and followed their longtime veterinarian's advice. Riley presented with common clinical signs of canine hyperadrenocorticism — polyuria and polydipsia, polyphagia, alopecia, and a pendulous abdomen.

Diagnosing canine hyperadrenocorticism can be fairly straightforward based on a dog's history, clinical signs, and results of readily available diagnostic tests (see the previous Canine Cushing's Case Files in this series, 'Dali,' 'Princess,' and 'Mitch'). Examination and screening for other concurrent disease processes is also indicated.

Once the diagnosis is confirmed, VETORYL® CAPSULES (trilostane), the only FDA-approved drug indicated for medical treatment of both pituitary- and adrenal-dependent hyperadrenocorticism in dogs, can be prescribed.

Initial diagnostic test and treatment fees

Riley's evaluation and test results confirmed hyperadrenocorticism. Table 1 lists the fees associated with riley's diagnostic workup and her initial treatment with VETORYL Capsules.

TABLE 1: Initial diagnostic test and treatment costs

Monitoring fees

After 10 to 14 days of treatment with VETORYL Capsules, a physical examination and adrenocorticotropic hormone (ACTH) stimulation test should be performed. once an optimum dose of VETORYL Capsules has been reached, the dog should be re-examined at 30 days, 90 days, and then every three months thereafter OR 10 to 14 days after any change in the dose of VETORYL Capsules. This diagnostic and monitoring plan has long-term benefits not only for the patient, but also for a practice's finances.

Table 2 (on the next page) lists some of the fees associated with monitoring riley while she receives VETORYL Capsules treatment from Day 14 through two years and beyond. With quarterly visits, the owners bond with the practice and develop a good rapport and strong relationship with the veterinary team.

TABLE 2: Treatment and monitoring costs (standard markup)

Consider reducing markup

As price decreases, quantity consumed generally increases. Thus for patients with chronic diseases such as hyperadrenocorticism, consider that a typical practice markup on charges may not be required. In Riley's case example, a practice's annual out-of-pocket cost (without production-based doctor compensation) in Year 2 and beyond is $958 ($239.50 ՠ4), and the client cost is $2,056 (Table 2). Therefore, the profit margin per dog is 53.4% ([$2,056 – $958]/$2,056).

A greater number of clients may be able to follow through with their pets' long-term treatment and monitoring if the costs were lower. For example, if the markup on VETORYL® CAPSULES (trilostane) was reduced (to that similar to the markup [45%] on a therapeutic diet for a patient with a chronic condition), and if the markup on diagnostic tests was similarly reduced, consider the costs listed in Table 3.

TABLE 3: Treatment and monitoring costs (reduced markup)

Table 3 shows that a practice could offer savings for clients with pets that have chronic disease and still receive an acceptable gross income and net profit. Some clients would be able to treat their dogs at the annual cost of $2,056, but many more clients should be able and willing to treat at $1,528 per year.

Each practice will have a specific pricing structure, which results in a given volume that maximizes profit. That topic is beyond the scope of this article, but pricing flexibility in chronic disease management is worth considering, as illustrated here with canine Cushing's syndrome. Keep in mind that a 100%, 200%, or 300% markup on drugs and diagnostic tests times zero (i.e., no pet owner is willing to purchase) is zero.

Package pricing options

Consider additional options for patient care and improving profits in your practice when managing dogs with Cushing's syndrome. Once a patient's clinical signs are well controlled, offering a discounted wellness plan that includes charges for the necessary chronic disease management follow-up appointments, laboratory work, and supply of VETORYL Capsules may improve client participation. A package pricing structure might increase the number of clients willing to continue treatment and monitoring. Veterinarians already commonly use package pricing for new puppy visits, preventive care, and preanesthetic screenings. By packaging these goods and services and ensuring a commitment early, you are more likely to gain owner compliance, thereby improving both patient wellbeing and practice revenue.

Good for patients and the practice bottom line

Clearly, diagnosing and treating canine Cushing's syndrome is an investment for clients and practices. Fortunately, reducing or eliminating clinical signs of chronic disease enhances the quality of life for both the dog and its owner. Managing canine Cushing's syndrome with VETORYL Capsules is not only good medicine, but it also contributes handsomely to the gross and net income of the practice. You will be seeing these patients for monitoring appointments and all of their wellness and health care needs for years to come. Furthermore, the pet owner now has a success story to share with other potential clients.

In order to help more pets and pet owners, while still increasing your gross and net income, consider flexibility in your pricing structure for patients that require long-term disease management. When you identify canine Cushing's syndrome cases and you have questions about treatment, you can contact the Dechra Veterinary Products Technical Services Team (at 866-933-2472) for assistance in successfully managing these patients.

* Riley is not an actual patient; this case example is provided for illustrative purposes only.

Mr. Wood is a certified public accountant and a certified financial planner who consults with veterinarians and the veterinary industry. Mr. Wood has served on the Board of Directors of the American Veterinary Medical Foundation and on the Pricing Subcommittee of the National Commission on Veterinary Economic Issues.

Learn more with these online resources

Go to the Dechra Veterinary Products CE Learning Center at and choose one of the online CE modules to learn the latest on managing feline hyperthyroidism and canine hyperadrenocorticism. Plus earn free CE!

• Diagnosing and treating canine hyperadrenocorticism

Presented by Audrey K. Cook, BVM&S, MRCVS, DACVIM, DECVIM, and David s. Bruyette, DVM, DACVIM

• Cushing's disease: Inside and out

Rhonda Schulman DVM, DACVIM, and John Angus, DVM, DACVD

• Diagnosing and treating feline hyperthyroidism

Presented by Andrew J. Rosenfeld, DVM, DABVP

Then get your whole team on the same page, by visiting the Team Meeting in A Box section at

• Stop getting burned by ear infections

How you handle otitis externa and ear infections can make or break client bonds—and dogs' well-being. Use this Team meeting in a Box to create a team approach to help pet owners and heal patients.

• Coping with Cushing's syndrome

Pets with Cushing's syndrome suffer from a chronic illness that will be managed throughout the pet's life, not cured. This Team Meeting in A Box will help you deliver a successful team-wide approach.

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