Annette M Ilg1, Aaron A Laviana2, Mitchell Kamrava3, Darlene Veruttipong3, Michael Steinberg3, Sang-June Park3, Michael A Burke4, Douglas Niedzwiecki5, Patrick A Kupelian3, Christopher Saigal2. 1. Department of Urology, Institute of Urologic Oncology, David Geffen School of Medicine at University of California, Los Angeles, CA. Electronic address: amilg@bidmc.harvard.edu. 2. Department of Urology, Institute of Urologic Oncology, David Geffen School of Medicine at University of California, Los Angeles, CA. 3. Department of Radiation Oncolgoy, David Geffen School of Medicine at University of California, Los Angeles, CA. 4. Performance Excellence, Los Angeles Health System, University of California, Los Angeles, CA. 5. Operative Services, Los Angeles Health System, University of California, Los Angeles, CA.
Abstract
PURPOSE: Cost estimates through traditional hospital accounting systems are often arbitrary and ambiguous. We used time-driven activity-based costing (TDABC) to determine the true cost of low-dose-rate (LDR) and high-dose-rate (HDR) brachytherapy for prostate cancer and demonstrate opportunities for cost containment at an academic referral center. METHODS AND MATERIALS: We implemented TDABC for patients treated with I-125, preplanned LDR and computed tomography based HDR brachytherapy with two implants from initial consultation through 12-month followup. We constructed detailed process maps for provision of both HDR and LDR. Personnel, space, equipment, and material costs of each step were identified and used to derive capacity cost rates, defined as price per minute. Each capacity cost rate was then multiplied by the relevant process time and products were summed to determine total cost of care. RESULTS: The calculated cost to deliver HDR was greater than LDR by $2,668.86 ($9,538 vs. $6,869). The first and second HDR treatment day cost $3,999.67 and $3,955.67, whereas LDR was delivered on one treatment day and cost $3,887.55. The greatest overall cost driver for both LDR and HDR was personnel at 65.6% ($4,506.82) and 67.0% ($6,387.27) of the total cost. After personnel costs, disposable materials contributed the second most for LDR ($1,920.66, 28.0%) and for HDR ($2,295.94, 24.0%). CONCLUSIONS: With TDABC, the true costs to deliver LDR and HDR from the health system perspective were derived. Analysis by physicians and hospital administrators regarding the cost of care afforded redesign opportunities including delivering HDR as one implant. Our work underscores the need to assess clinical outcomes to understand the true difference in value between these modalities. Copyright Â
PURPOSE: Cost estimates through traditional hospital accounting systems are often arbitrary and ambiguous. We used time-driven activity-based costing (TDABC) to determine the true cost of low-dose-rate (LDR) and high-dose-rate (HDR) brachytherapy for prostate cancer and demonstrate opportunities for cost containment at an academic referral center. METHODS AND MATERIALS: We implemented TDABC for patients treated with I-125, preplanned LDR and computed tomography based HDR brachytherapy with two implants from initial consultation through 12-month followup. We constructed detailed process maps for provision of both HDR and LDR. Personnel, space, equipment, and material costs of each step were identified and used to derive capacity cost rates, defined as price per minute. Each capacity cost rate was then multiplied by the relevant process time and products were summed to determine total cost of care. RESULTS: The calculated cost to deliver HDR was greater than LDR by $2,668.86 ($9,538 vs. $6,869). The first and second HDR treatment day cost $3,999.67 and $3,955.67, whereas LDR was delivered on one treatment day and cost $3,887.55. The greatest overall cost driver for both LDR and HDR was personnel at 65.6% ($4,506.82) and 67.0% ($6,387.27) of the total cost. After personnel costs, disposable materials contributed the second most for LDR ($1,920.66, 28.0%) and for HDR ($2,295.94, 24.0%). CONCLUSIONS: With TDABC, the true costs to deliver LDR and HDR from the health system perspective were derived. Analysis by physicians and hospital administrators regarding the cost of care afforded redesign opportunities including delivering HDR as one implant. Our work underscores the need to assess clinical outcomes to understand the true difference in value between these modalities. Copyright Â
Authors: Greg Suralik; Sonali Rudra; Sunil W Dutta; Jialu Yu; Jason C Sanders; Michael D Schad; Einsley-Marie Janowski; Lucy Su; Bruce Libby; Shayna L Showalter; Jennifer M Lobo; Timothy N Showalter Journal: Brachytherapy Date: 2020-03-28 Impact factor: 2.362
Authors: Justin Barnes; William R Kennedy; Benjamin W Fischer-Valuck; Brian C Baumann; Jeff M Michalski; Hiram A Gay Journal: J Contemp Brachytherapy Date: 2019-08-29