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

Abstract

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.

Challenges in the Analysis of Outcomes for Surgical Compared to Radiotherapy Treatment of Prostate Cancer

“…Other studies have focused on comparisons among surgical techniques (28)(29)(30). Perhaps the most pertinent studies have looked at the costs among various treatment modalities, including radiotherapy, surgery, or active surveillance (31)(32)(33)(34)(35)(36). Consistent with the body of literature, in vivo 32: 113-120 (2018) 118 our findings suggest that the cost of EBRT significantly outpaces the costs of surgery or brachytherapy.…”

Cost of New Technologies in Prostate Cancer Treatment: Systematic Review of Costs and Cost Effectiveness of Robotic-assisted Laparoscopic Prostatectomy, Intensity-modulated Radiotherapy, and Proton Beam Therapy

“…However, understanding the value of treatment with new technologies will become increasingly important as society and policy makers are moving toward accountable care organizations, bundled payments, and value-based reimbursement [59]. Since value is defined as outcomes relative to cost [60], we will need more accurate ways of capturing cost and outcomes of treatment using approaches such as time-driven activity-based costing [61] and prospective population-based prostate cancer registries [62]. We encourage clinicians and patients to participate in such registries whenever possible.…”

Integration of Multiparametric MRI Into Active Surveillance of Prostate Cancer

“…This may cause a larger discrepancy between mpMRI/TRUS fusion biopsy and TRUS biopsy at other centers in the USA. Even so, this study found that active surveillance incorporating mpMRI and MRI/ TRUS fusion biopsies is still of lowest cost when compared with other interventions for prostate cancer for at least 7 years of follow-up due to the superior detection of clinically significant prostate cancer and more appropriate selection of patients for active surveillance rather than definitive treatment [93].…”

“…It is important to note that mpMRI/TRUS fusion biopsy is significantly more expensive than conventional TRUS biopsy because of the higher costs associated with mpMRI for personnel and equipment, image interpretation and image handling [93]. MpMRI/ TRUS fusion biopsy was four-times higher than TRUS biopsy in one study by Laviana et al, though the study authors acknowledge that their estimated cost of MRI is significantly lower than the national average [93]. This may cause a larger discrepancy between mpMRI/TRUS fusion biopsy and TRUS biopsy at other centers in the USA.…”