Ning Matthew S, Klopp Ann H, Jhingran Anuja, Lin Lilie L, Eifel Patricia J, Vedam Sastry, Lawyer Ann A, Olivieri Nicholas D, Guzman Alexis B, Incalcaterra James R, Mesko Shane M, Pezzi Todd A, Boyce-Fappiano David R, Shaitelman Simona F, Frank Steven J, Thaker Nikhil G
Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX.
Department of Finance, The University of Texas MD Anderson Cancer Center, Houston, TX.
Brachytherapy. 2019 Jul-Aug;18(4):445-452. doi: 10.1016/j.brachy.2019.03.003. Epub 2019 Apr 13.
The purpose of this study was to quantify the cost of resources required to deliver adjuvant radiation therapy (RT) for high- to intermediate-risk endometrial cancer using time-driven activity-based costing (TDABC).
Comparisons were made for three and five fractions of vaginal cuff brachytherapy (VCB), 28 fractions of intensity-modulated radiation therapy (IMRT), and combined modality RT (25-fraction IMRT followed by 2-fraction VCB). Process maps were developed representing each phase of care. Salary and equipment costs were obtained to derive capacity cost rates, which were multiplied by process times and summed to calculate total costs. Costs were compared with 2018 Medicare physician fee schedule reimbursement.
Full cycle costs for 5-fraction VCB, IMRT, and combined modality RT were 42%, 61%, and 93% higher, respectively, than for 3-fraction VCB. Differences were attributable to course duration and number of fractions/visits. Accumulation of cost throughout the cycle was steeper for VCB, rising rapidly within a shorter time frame. Personnel cost was the greatest driver for all modalities, constituting 76% and 71% of costs for IMRT and VCB, respectively, with VCB requiring 74% more physicist time. Total reimbursement for 5-fraction VCB was 40% higher than for 3-fractions. Professional reimbursement for IMRT was 31% higher than for 5-fraction VCB, vs. IMRT requiring 43% more physician TDABC than 5-fraction VCB.
TDABC is a feasible methodology to quantify the cost of resources required for delivery of adjuvant IMRT and brachytherapy and produces directionally accurate costing data as compared with reimbursement calculations. Such data can inform institution-specific financial analyses, resource allocation, and operational workflows.
本研究的目的是使用时间驱动作业成本法（TDABC）来量化为高风险至中风险子宫内膜癌提供辅助放射治疗（RT）所需的资源成本。
对阴道残端近距离放射治疗（VCB）的3次和5次分割、调强放射治疗（IMRT）的28次分割以及联合模式放疗（25次分割IMRT后接2次分割VCB）进行了比较。绘制了代表护理各阶段的流程图。获取了薪资和设备成本以得出单位产能成本率，将其乘以流程时间并求和以计算总成本。将成本与2018年医疗保险医师费用表报销情况进行了比较。
5次分割VCB、IMRT和联合模式放疗的全周期成本分别比3次分割VCB高42%、61%和93%。差异归因于疗程持续时间和分割次数/就诊次数。VCB在整个周期内成本积累更为陡峭，在较短时间内迅速上升。人员成本是所有模式中最大的成本驱动因素，分别占IMRT和VCB成本的76%和71%，VCB所需的物理师时间多74%。5次分割VCB的总报销比3次分割高40%。IMRT的专业报销比5次分割VCB高31%، 而IMRT所需的医师TDABC比5次分割VCB多43%。
TDABC是一种可行的方法，可用于量化提供辅助IMRT和近距离放射治疗所需的资源成本，并且与报销计算相比，能产生方向准确的成本核算数据。这些数据可为机构特定的财务分析、资源分配和运营工作流程提供参考。
