Ridderstråle Martin
1 Department of Clinical Sciences, Lund University, Malmö, Sweden.
J Diabetes Sci Technol. 2017 Jul;11(4):759-765. doi: 10.1177/1932296816684858. Epub 2017 Jan 5.
Depending on available resources, competencies, and pedagogic preference, initiation of insulin pump therapy can be performed on either an individual or a group basis. Here we compared the two models with respect to resources used.
Time-driven activity-based costing (TDABC) was used to compare initiating insulin pump treatment in groups (GT) to individual treatment (IT). Activities and cost drivers were identified, timed, or estimated at location. Medical quality and patient satisfaction were assumed to be noninferior and were not measured.
GT was about 30% less time-consuming and 17% less cost driving per patient and activity compared to IT. As a batch driver (16 patients in one group) GT produced an upward jigsaw-shaped accumulative cost curve compared to the incremental increase incurred by IT. Taking the alternate cost for those not attending into account, and realizing the cost of opportunity gained, suggested that GT was cost neutral already when 5 of 16 patients attended, and that a second group could be initiated at no additional cost as the attendance rate reached 15:1.
We found TDABC to be effective in comparing treatment alternatives, improving cost control and decision making. Everything else being equal, if the setup is available, our data suggest that initiating insulin pump treatment in groups is far more cost effective than on an individual basis and that TDABC may be used to find the balance point.
根据可用资源、能力和教学偏好，胰岛素泵治疗可以以个体或小组的方式开始。在此，我们比较了这两种模式在资源使用方面的情况。
采用时间驱动作业成本法（TDABC）比较小组启动胰岛素泵治疗（GT）与个体治疗（IT）。确定活动和成本动因，并在现场进行计时或估算。假定医疗质量和患者满意度无差异，未进行测量。
与IT相比，GT每位患者每次活动的耗时约少30%，成本动因约少17%。作为批量动因（一组16名患者），与IT产生的增量增加相比，GT产生了向上的拼图状累积成本曲线。考虑到未参加者的替代成本，并认识到获得的机会成本，表明当16名患者中有5名参加时，GT已经成本中性，并且随着出勤率达到15:1，无需额外成本即可启动第二组。
我们发现TDABC在比较治疗方案、改善成本控制和决策方面是有效的。在其他条件相同的情况下，如果具备相应条件，我们的数据表明，小组启动胰岛素泵治疗比个体治疗更具成本效益，并且TDABC可用于找到平衡点。
