Time-driven activity based costing of total knee replacement surgery at a London teaching hospital

Chen, Alvin; Sabharwal, Sanjeeve; Akhtar, Kash; Makaram, Navnit; Gupte, Chinmay

doi:10.1016/j.knee.2015.07.006

Cited by 57 publications

(36 citation statements)

References 19 publications

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“…Instead summary costs were presented with limited disaggregation of individual costs or transparency regarding precisely which resources had been included making meaningful interpretation difficult. Some good examples of micro-costing surgical interventions, however, were identified [16,17] and have subsequently been published [18]. There was significant variation in which aspects of the patient pathway researchers elected to micro-cost.…”

Section: Discussionmentioning

confidence: 99%

The use of micro-costing in economic analyses of surgical interventions: a systematic review

Potter

Davies

et al. 2020

Health Econ Rev

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Background: Compared with conventional top down costing, micro-costing may provide a more accurate method of resource-use assessment in economic analyses of surgical interventions, but little is known about its current use. The aim of this study was to systematically-review the use of micro-costing in surgery. Methods: Comprehensive searches identified complete papers, published in English reporting micro-costing of surgical interventions up to and including 22nd June 2018. Studies were critically appraised using a modified version of the Consensus on Health Economic Criteria (CHEC) Checklist. Study demographics and details of resources identified; methods for measuring and valuing identified resources and any cost-drivers identified in each study were summarised. Results: A total of 85 papers were identified. Included studies were mainly observational comparative studies (n = 42, 49.4%) with few conducted in the context of a randomised trial (n = 5, 5.9%). The majority of studies were single-centre (n = 66, 77.6%) and almost half (n = 40, 47.1%) collected data retrospectively. Only half (n = 46, 54.1%) self-identified as being 'micro-costing' studies. Rationale for the use of micro-costing was most commonly to compare procedures/techniques/processes but over a third were conducted specifically to accurately assess costs and/or identify cost-drivers. The most commonly included resources were personnel costs (n = 76, 89.4%); materials/disposables (n = 76, 89.4%) and operating-room costs (n = 62,72.9%). No single resource was included in all studies. Most studies (n = 72, 84.7%) identified key cost-drivers for their interventions. Conclusions: There is lack of consistency regarding the current use of micro-costing in surgery. Standardising terminology and focusing on identifying and accurately costing key cost-drivers may improve the quality and value of micro-costing in future studies. Trial registration: PROSPERO registration CRD42018099604.

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Section: Discussionmentioning

confidence: 99%

The use of micro-costing in economic analyses of surgical interventions: a systematic review

Potter

Davies

et al. 2020

Health Econ Rev

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“…Reimbursement contracts that include outcomes will stimulate the VBHC approach and promote bundled pathways that deliver it 48 49. Accurate economic evaluation forms the denominator to the value equation and considering the merits of TDABC against PLICS is important going forward 38 40 50. This study found the PLICS data to be challenging, and a significant amount of work was required to verify its individual components.…”

Section: Discussionmentioning

confidence: 99%

Value-based healthcare analysis of joint replacement surgery for patients with primary hip osteoarthritis

et al. 2019

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BackgroundA quarter of the population present at least once a year with a musculoskeletal disorder. Primary hip osteoarthritis is a high-volume condition with significant clinical need and population-level costs. There remains much variation in patient outcomes and care delivery costs for this condition.AimsThe study aimed to gauge if pathway redesign based on the principles of value-based healthcare (VBHC) could increase value. The aim was to calculate the value of treatment for primary hip osteoarthritis through measuring outcomes that matter to patients, as well as the costs of delivering them. Additionally it aimed to compare two care pathways to identify which elements may better promote the delivery of high-value clinical care.MethodsTwo care models were evaluated: the first being a traditional model with multiple entry points and without pathway standardisation, and the second an intentionally designed standardised multidisciplinary pathway. Mandated National Health Service patient-reported outcomes were assessed but were restructured into a patient-centred format to assess the impact on pain, function and psychological outcomes. Patient-level pathway economic evaluation was performed. Using these data, outcomes were mapped against cost to calculate value.ResultsThere were no significant differences in clinical outcomes between the two models. The intentionally designed model delivered better value care, having lower pathway costs. This model produced a small but inconsistent positive financial margin.ConclusionsIntentionally designed, integrated elective services offer an opportunity to develop and evaluate VBHC models. Analysis of two care pathways from a VBHC perspective demonstrated that an intentionally designed pathway had higher value. The higher value pathway maximised the benefits of having physiotherapists and orthopaedic surgeons working side by side. Developing and measuring patient-orientated outcomes and performing accurate economic evaluation are the key to understanding and achieving better value care.

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“…Para a implementação do método TDABC, é necessário que haja suporte dos líderes executivos, financeiros e clínicos, bem como apoio da equipe multidisciplinar (Martin et al, 2018;Chen et al, 2015). O estudo se iniciou com a contextualização por meio de entrevistas com os envolvidos.…”

Section: Contextualizaçãounclassified

Custeio Baseado em Atividade e Tempo (TDABC) em um departamento de radiologia hospitalar no sul do Brasil

Daroit¹,

Ruschel²,

Tarrago³

et al. 2018

JBES

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Objetivo: Mensurar o custo dos serviços do departamento de radiologia de um hospital privado no sul do Brasil e avaliar o desempenho financeiro do setor quando comparado ao repasse da tabela aos hospitais do Sistema Único de Saúde (SUS). Métodos: Estudo de caso baseado na metodologia Custeio Baseado em Atividade e Tempo (TDABC). Após a definição dos exames de maior incidência, houve a análise do processo de realização de exames de radiografia de tórax, ecografia de abdômen total, tomografia de crânio, tomografia de tórax, ecografia pélvica transvaginal, ecografia de aparelho urinário e ressonância magnética de crânio. Foram coletados os tempos das atividades para a realização de cada exame, informações dos custos do departamento, bem como as definições das capacidades dos serviços para calcular o custo dos exames em função das atividades e tempo. Resultados: Pode-se inferir que, na comparação com os valores de repasse do SUS, todos os exames analisados apresentaram custos superiores ao repasse. Além disso, observou-se que cerca de 80% dos custos estão relacionados ao custo fixo da estrutura do departamento de radiologia e 12%, ao profissional médico. Conclusão: O TDABC demonstrou ser um método oportuno para análise de custeio em um departamento de radiologia hospitalar. Por meio dos resultados apresentados, pode-se propor melhorias a fim de reduzir custos para um maior desempenho do serviço.

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Time-driven activity based costing of total knee replacement surgery at a London teaching hospital

Cited by 57 publications

References 19 publications

The use of micro-costing in economic analyses of surgical interventions: a systematic review

The use of micro-costing in economic analyses of surgical interventions: a systematic review

Value-based healthcare analysis of joint replacement surgery for patients with primary hip osteoarthritis

Custeio Baseado em Atividade e Tempo (TDABC) em um departamento de radiologia hospitalar no sul do Brasil

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