Time-driven activity-based costing of low-dose-rate and high-dose-rate brachytherapy for low-risk prostate cancer

Ilg, Annette M.; Laviana, Aaron A.; Kamrava, Mitchell; Veruttipong, Darlene; Steinberg, Michael; Park, Sang-June; Burke, Michael A.; Niedzwiecki, Douglas; Kupelian, Patrick A.; Saigal, Christopher S.

doi:10.1016/j.brachy.2016.08.008

Cited by 26 publications

(6 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Previous TDABC analyses on prostate and cervical cancer brachytherapy displayed personnel costs ranging from 50%-67% of total care. 27,28 The significantly higher proportion of personnel costs in the current study results from the absence of operating room technical costs as well as the relatively shortened treatment time associated with spinal irradiation. Elevated personnel costs with SSRS were attributable to increased physician and physicist time required for the simulation, planning, and treatment delivery.…”

Section: Discussionmentioning

confidence: 84%

“…36 The most significant limitation of this study is its singleinstitution nature, mirroring prior TDABC analyses. [24][25][26][27][28] TDABC costs are highly variable between different institutions because of multiple regionally varying factors such as patient demographics, operational workflows, treatment standards, and practice structures (eg, academic v private). In particular, this study did not incorporate the use of relative value units, a common component of physician reimbursement at other settings that can pose particular challenges for activity-based cost analyses.…”

Section: Discussionmentioning

confidence: 99%

“…22,23 TDABC has been successfully used in multiple radiation oncology studies exploring the cost of treatments for prostate, cervical, and breast cancer. [24][25][26][27][28][29] In this study, we perform a TDABC analysis to evaluate and compare the overall resource utilization of several RT modalities for spine metastases.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Time-Driven, Activity-Based Cost Analysis of Radiation Treatment Options for Spinal Metastases

Boyce-Fappiano

Ning

Thaker

et al. 2020

JCO Oncology Practice

View full text Add to dashboard Cite

PURPOSE: Several treatment options for spinal metastases exist, including multiple radiation therapy (RT) techniques: three-dimensional (3D) conventional RT (3D-RT), intensity-modulated RT (IMRT), and spine stereotactic radiosurgery (SSRS). Although data exist regarding reimbursement differences across regimens, differences in provider care delivery costs have yet to be evaluated. We quantified institutional costs associated with RT for spinal metastases, using a time-driven activity-based costing model. METHODS: Comparisons were made between (1) 10-fraction 3D-RT to 30 Gy, (2) 10-fraction IMRT to 30 Gy, (3) 3-fraction SSRS (SSRS-3) to 27 Gy, and (4) single-fraction SSRS (SSRS-1) to 18 Gy. Process maps were developed from consultation through follow-up 30 days post-treatment. Process times were determined through panel interviews, and personnel costs were extracted from institutional salary data. The capacity cost rate was determined for each resource, then multiplied by activity time to calculate costs, which were summed to determine total cost. RESULTS: Full-cycle costs of SSRS-1 were 17% lower and 17% higher compared with IMRT and 3D-RT, respectively. Full-cycle costs for SSRS-3 were only 1% greater than 10-fraction IMRT. Technical costs for IMRT were 50% and 77% more than SSRS-3 and SSRS-1. In contrast, personnel costs were 3% and 28% higher for SSRS-1 than IMRT and 3D-RT, respectively ( P < .001). CONCLUSIONS: Resource utilization varies significantly among treatment options. By quantifying provider care delivery costs, this analysis supports the institutional resource efficiency of SSRS-1. Incorporating clinical outcomes with such resource and cost data will provide additional insight into the highest value modalities and may inform alternative payment models, operational workflows, and institutional resource allocation.

show abstract

Section: Discussionmentioning

confidence: 84%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Time-Driven, Activity-Based Cost Analysis of Radiation Treatment Options for Spinal Metastases

Boyce-Fappiano

Ning

Thaker

et al. 2020

JCO Oncology Practice

View full text Add to dashboard Cite

show abstract

“…The largest group (n=10) of TDABC studies measured costs across care paths within a single provider and for a single diagnosis. 9 10 31 33 38 43 45 46 52 54 Typically, these studies compared costs between a new intervention and the ‘usual’ care, 9 10 31 46 53 54 or between alternative care paths 33 38 43 52 in order to measure cost savings.…”

Section: Resultsmentioning

confidence: 99%

Cost measurement in value-based healthcare: a systematic review

et al. 2022

View full text Add to dashboard Cite

ObjectiveAlthough value-based healthcare (VBHC) views accurate cost information to be crucial in the pursuit of value, little is known about how the costs of care should be measured. The aim of this review is to identify how costs are currently measured in VBHC, and which cost measurement methods can facilitate VBHC or value-based decision making.DesignTwo reviewers systematically search the PubMed/MEDLINE, Embase, EBSCOhost and Web of Science databases for publications up to 1 January 2022 and follow Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to identify relevant studies for further analysis.Eligibility criteriaStudies should measure the costs of an intervention, treatment or care path and label the study as ‘value based’. An inductive qualitative approach was used to identify studies that adopted management accounting techniques to identify if or how cost information facilitated VBHC by aiding decision-making.ResultsWe identified 1930 studies, of which 215 measured costs in a VBHC setting. Half of these studies measured hospital costs (110, 51.2%) and the rest relied on reimbursement amounts. Sophisticated costing methods that allocate both direct and indirect costs to care paths were seen as able to provide valuable managerial information by facilitating care path adjustments (39), benchmarking (38), the identification of cost drivers (47) and the measurement of total costs or cost savings (26). We found three best practices that were key to success in cost measurement: process mapping (33), expert input (17) and observations (24).ConclusionsCost information can facilitate VBHC. Time-driven activity-based costing (TDABC) is viewed as the best method although its ability to inform decision-making depends on how it is implemented. While costing short, or partial, care paths and surgical episodes produces accurate cost information, it provides only limited decision-making information. Practitioners are advised to focus on costing full care cycles and to consider both direct and indirect costs through TDABC.

show abstract

“…The price of HDR may also compare favorably relative to LDR. It has been suggested that single-fraction HDR monotherapy is least expensive ($9,850), followed by laparoscopic surgery ($11,098), then open radical prostatectomy ($13,829), and LDR brachytherapy ($13,893), with combined EBRT and BT being the most expensive ($18,819); however, another study suggested that HDR may become more expensive than LDR ($6,869), with increasing fractions (single fraction: $5,582; multifraction: $9,538) [33,34]. Interestingly, the use of HDR brachytherapy has been shown to be increasing in Europe, contrary to the findings of our current study in a large, United States-based cohort [35].…”

Section: Discussionmentioning

confidence: 99%

Treatment patterns of high-dose-rate and low-dose-rate brachytherapy as monotherapy for prostate cancer

Barnes

Kennedy

Fischer‐Valuck

et al. 2019

jcb

View full text Add to dashboard Cite

Purpose: Monotherapy with high-dose-rate (HDR) or low-dose-rate (LDR) brachytherapy are both recommended modalities for prostate cancer. The choice between HDR and LDR is dependent on patient, physician, and hospital preferences. We sought to identify treatment patterns and factors associated with receipt of HDR or LDR monotherapy. Material and methods: We queried the National Cancer Database (NCDB) for patients with localized low-or intermediate-risk prostate cancer treated with HDR or LDR monotherapy. Descriptive statistics were used to analyze patterns of HDR vs. LDR. Patient characteristics were correlated with HDR vs. LDR using multivariable logistic regression.

show abstract

Time-driven activity-based costing of low-dose-rate and high-dose-rate brachytherapy for low-risk prostate cancer

Cited by 26 publications

References 27 publications

Time-Driven, Activity-Based Cost Analysis of Radiation Treatment Options for Spinal Metastases

Time-Driven, Activity-Based Cost Analysis of Radiation Treatment Options for Spinal Metastases

Cost measurement in value-based healthcare: a systematic review

Treatment patterns of high-dose-rate and low-dose-rate brachytherapy as monotherapy for prostate cancer

Contact Info

Product

Resources

About