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
Department of Urology, Institute of Urologic Oncology, David Geffen School of Medicine at University of California, Los Angeles, CA.
Department of Urology, Institute of Urologic Oncology, David Geffen School of Medicine at University of California, Los Angeles, CA.
Brachytherapy. 2016 Nov-Dec;15(6):760-767. doi: 10.1016/j.brachy.2016.08.008. Epub 2016 Oct 4.
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.
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.
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%).
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.
通过传统医院会计系统进行的成本估算往往具有随意性和模糊性。我们采用时间驱动作业成本法（TDABC）来确定前列腺癌低剂量率（LDR）和高剂量率（HDR）近距离放射治疗的真实成本，并展示在学术转诊中心控制成本的机会。
我们对接受I-125、预计划LDR和基于计算机断层扫描的HDR近距离放射治疗且进行了两次植入的患者实施了TDABC，从初始咨询到12个月随访。我们构建了提供HDR和LDR的详细流程图。确定了每个步骤的人员、空间、设备和材料成本，并用于得出产能成本率，定义为每分钟的价格。然后将每个产能成本率乘以相关的流程时间，并对各项成本进行汇总，以确定护理总成本。
计算得出的HDR交付成本比LDR高2668.86美元（9538美元对6869美元）。第一次和第二次HDR治疗日的成本分别为3999.67美元和3955.67美元，而LDR在一个治疗日完成，成本为3887.55美元。LDR和HDR总体成本的最大驱动因素均为人员成本，分别占总成本的65.6%（4506.82美元）和67.0%（6387.27美元）。在人员成本之后，一次性材料对LDR成本的贡献次之（1920.66美元，28.0%），对HDR成本的贡献次之（2295.94美元，24.0%）。
通过TDABC，从卫生系统的角度得出了LDR和HDR的真实成本。医生和医院管理人员对护理成本的分析提供了重新设计的机会，包括将HDR作为一次植入进行交付。我们的工作强调需要评估临床结果，以了解这些治疗方式在价值上的真正差异。
