Measuring the cost of care in benign prostatic hyperplasia using time-driven activity-based costing (TDABC)

Kaplan, Alan L.; Agarwal, Neha; Setlur, N.P.; Tan, Hung‐Jui; Niedzwiecki, Douglas; McLaughlin, Nancy; Burke, Michael A.; Steinberg, Kathy; Chamie, Karim; Saigal, Christopher S.

doi:10.1016/j.hjdsi.2014.09.007

Cited by 58 publications

(27 citation statements)

References 17 publications

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“…With personnel, we used the entire calendar year but factored in time unavailable because of vacations, breaks, weekends, and continuing education requirements. We estimated that attending surgeons worked 10.5 hours per day, including work from home, and this gave them an estimated personnel capacity of 137,469 minutes . Finally, the capacity cost rate of every resource was calculated by the division of the complete costs of supplying a resource by its available or functional capacity.…”

Section: Methodsmentioning

confidence: 99%

Utilizing time‐driven activity‐based costing to understand the short‐ and long‐term costs of treating localized, low‐risk prostate cancer

Laviana

Ilg

Veruttipong

et al. 2015

Cancer

131

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BACKGROUND: Given the costs of delivering care for men with prostate cancer remain poorly described, this article reports the results of time-driven activity-based costing (TDABC) for competing treatments of low-risk prostate cancer. METHODS: Process maps were developed for each phase of care from the initial urologic visit through 12 years of follow-up for robotic-assisted laparoscopic prostatectomy (RALP), cryotherapy, high-dose rate (HDR) and low-dose rate (LDR) brachytherapy, intensity-modulated radiation therapy (IMRT), stereotactic body radiation therapy (SBRT), and active surveillance (AS). The last modality incorporated both traditional transrectal ultrasound (TRUS) biopsy and multiparametric-MRI/TRUS fusion biopsy. The costs of materials, equipment, personnel, and space were calculated per unit of time and based on the relative proportion of capacity used. TDABC for each treatment was defined as the sum of its resources. RESULTS: Substantial cost variation was observed at 5 years, with costs ranging from $7,298 for AS to $23,565 for IMRT, and they remained consistent through 12 years of follow-up. LDR brachytherapy ($8,978) was notably cheaper than HDR brachytherapy ($11,448), and SBRT ($11,665) was notably cheaper than IMRT, with the cost savings attributable to shorter procedure times and fewer visits required for treatment. Both equipment costs and an inpatient stay ($2,306) contributed to the high cost of RALP ($16,946). Cryotherapy ($11,215) was more costly than LDR brachytherapy, largely because of increased singleuse equipment costs ($6,292 vs $1,921). AS reached cost equivalence with LDR brachytherapy after 7 years of follow-up. CONCLU-SIONS: The use of TDABC is feasible for analyzing cancer services and provides insights into cost-reduction tactics in an era focused on emphasizing value. By detailing all steps from diagnosis and treatment through 12 years of follow-up for low-risk prostate cancer, this study has demonstrated significant cost variation between competing treatments. Cancer 2016;122:447-55. V C 2015 American Cancer Society.

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Section: Methodsmentioning

confidence: 99%

Utilizing time‐driven activity‐based costing to understand the short‐ and long‐term costs of treating localized, low‐risk prostate cancer

Laviana

Ilg

Veruttipong

et al. 2015

Cancer

131

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“…If left untreated, complications such as urinary retention, renal insufficiency and bladder stone can occur, requiring surgical intervention. BPH has also been associated with other medical morbidities, such as increased risk of falls 3 , reduced quality of life 4 as well as increased annual healthcare cost 5 . As such, an understanding of the epidemiology of BPH is essential in health service planning as well as risk factor epidemiology.…”

Section: Introductionmentioning

confidence: 99%

The global burden of lower urinary tract symptoms suggestive of benign prostatic hyperplasia: A systematic review and meta-analysis

Lee

Chan

Lai

2017

Sci Rep

156

112

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Benign prostatic hyperplasia is a common non-malignant condition among older men, but the epidemiology is poorly characterised. We summarised and determined the global prevalence of benign prostatic hyperplasia. A systematic search on PubMed, EMBASE and CENTRAL was performed up until 31st July 2016. Studies that described the epidemiology of benign prostatic hyperplasia were included and cumulative plots of prevalence estimates were calculated. A total of 31 prevalence rate estimates from 25 countries were identified. The combined prevalence estimates showed that the lifetime prevalence of BPH was 26.2% (95% CI: 22.8–29.6%). We found that there was an increasing prevalence of BPH with age. However, we found no significant difference between (a) rural, urban or mixed sites, (b) different countries, (c) respondent representativeness. (d) sample size or (e) study quality. We also found no significant change in the prevalence over the past 20 years. While there is substantial variation between sites estimates, results suggest that nearly 1 in 4 men will suffer from BPH over their lifetime. The study revealed there are significant gaps in knowledge, which provides opportunities for future research to further enrich the epidemiological landscape with data.

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“…Examples of the application of TDABC have been mostly confined to medical conditions and to acute clinical settings. [18][19][20] This study seeks to add to this body of knowledge on the costs of care within outpatient environments through identifying the patient level cost of a variety of DSME programmes both cross-nationally and intranationally. 21 A primary objective was to provide a robust costing framework within which future studies could include clinical and quality of life outcomes to determine the economic value added to diabetes care through the use of DSME.…”

Section: Methodsmentioning

confidence: 99%

Patient level cost of diabetes self-management education programmes: an international evaluation

et al. 2017

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ObjectivesThe objective of this study was to examine the value of time-driven activity-based costing (TDABC) in understanding the process and costs of delivering diabetes self-management education (DSME) programmes in a multicountry comparative study.SettingOutpatient settings in five European countries (Austria, Denmark, Germany, Ireland, UK) and two countries outside Europe, Taiwan and Israel.ParticipantsProviders of DSME programmes across participating countries (N=16) including healthcare professionals, administrators and patients taking part in DSME programmes.Primary and secondary measuresPrimary measure: time spent by providers in the delivery of DSME and resources consumed in order to compute programme costs. Secondary measures: self-report measures of behavioural self-management and diabetes disease/health-related outcomes.ResultsWe found significant variation in costs and the processes of how DSME programmes are provided across and within countries. Variations in costs were driven by a combination of price variances, mix of personnel skill and efficiency variances. Higher cost programmes were not found to have achieved better relative outcomes. The findings highlight the value of TDABC in calculating a patient level cost and potential of the methodology to identify process improvements in guiding the optimal allocation of scarce resources in diabetes care, in particular for DSME that is often underfunded.ConclusionsThis study is the first to measure programme costs using estimates of the actual resources used to educate patients about managing their medical condition and is the first study to map such costs to self-reported behavioural and disease outcomes. The results of this study will inform clinicians, managers and policy makers seeking to enhance the delivery of DSME programmes. The findings highlight the benefits of adopting a TDABC approach to understanding the drivers of the cost of DSME programmes in a multicountry study to reveal opportunities to bend the cost curve for DSME.

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Measuring the cost of care in benign prostatic hyperplasia using time-driven activity-based costing (TDABC)

Cited by 58 publications

References 17 publications

Utilizing time‐driven activity‐based costing to understand the short‐ and long‐term costs of treating localized, low‐risk prostate cancer

Utilizing time‐driven activity‐based costing to understand the short‐ and long‐term costs of treating localized, low‐risk prostate cancer

The global burden of lower urinary tract symptoms suggestive of benign prostatic hyperplasia: A systematic review and meta-analysis

Patient level cost of diabetes self-management education programmes: an international evaluation

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