Harvard Medical School, Boston, Massachusetts; Harvard Business School, Boston, Massachusetts; Department of Radiology, Division of Vascular and Interventional Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Massachusetts; Newton-Wellesley Hospital, Newton, Massachusetts.
Chief, Division of Vascular and Interventional Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Massachusetts.
J Am Coll Radiol. 2021 Aug;18(8):1095-1105. doi: 10.1016/j.jacr.2021.03.027. Epub 2021 Apr 30.
To use time-drive activity-based costing (TDABC) to characterize and compare costs of transarterial chemoembolization (TACE), transarterial radioembolization (TARE), and ablation.
This three-part study involved (1) prospective observation to record resources used during TACE, TARE, and ablation and statistical evaluation of interobserver and interprocedure variability; (2) Bland-Altman analysis of prospective measurements and medical record time stamps to establish practicality of using retrospective data in place of direct observation; (3) retrospective time stamp assessment for 117 ablations, 61 TACE procedures, and 61 TARE procedures to reveal variability drivers.
Ablation costs were lowest ($3,744), which were 74% of TACE costs ($5,089) and 18% of TARE costs ($20,818). Consumables were the greatest cost contributor, accounting for 65% of ablation, 58% of TACE, and 90% of TARE costs. A single consumable contributed to most of the overall costs: the ablation probe (42%), ethiodized oil for TACE (30%), and yttrium-90 microspheres for TARE (80%). Bland-Altman analysis showed agreement between retrospective time stamps and prospective measurements. Ablation costs increased from $3,288 to $4,245 to $4,461 for one, two, or three tumors treated. TACE cost increased from $5,051 to $5,296 for lobar versus selective approaches.
A bottom-up costing approach using TDABC is feasible to assess true costs of hepatocellular carcinoma treatments and demonstrates ablation costs are significantly less than those of TACE and TARE. Replication of these methods at other institutions can facilitate development of a bundled payment model to promote utilization of locoregional therapies for hepatocellular carcinoma.
使用时间驱动作业成本法（TDABC）对经动脉化疗栓塞术（TACE）、经动脉放射性栓塞术（TARE）和消融术的成本进行特征描述和比较。
本三项研究包括：（1）前瞻性观察记录 TACE、TARE 和消融术中使用的资源，并对观察者间和程序间的变异性进行统计评估；（2）前瞻性测量和病历时间戳的 Bland-Altman 分析，以确定使用回顾性数据替代直接观察的实用性；（3）对 117 次消融术、61 次 TACE 术和 61 次 TARE 术进行回顾性时间戳评估，以揭示变异性驱动因素。
消融术的成本最低（3744 美元），为 TACE 成本（5089 美元）的 74%，为 TARE 成本（20818 美元）的 18%。耗材是最大的成本贡献者，占消融术的 65%、TACE 的 58%和 TARE 的 90%。一种单一的耗材对大部分总费用都有贡献：消融探针（42%）、TACE 用碘化油（30%）和 TARE 用钇-90 微球（80%）。Bland-Altman 分析表明，回顾性时间戳与前瞻性测量之间存在一致性。对于一个、两个或三个肿瘤的治疗，消融术的成本从 3288 美元增加到 4245 美元，再增加到 4461 美元。对于叶状和选择性方法，TACE 的成本从 5051 美元增加到 5296 美元。
使用 TDABC 的自下而上的成本评估方法可以评估肝癌治疗的真实成本，并表明消融术的成本明显低于 TACE 和 TARE。在其他机构复制这些方法可以促进为肝癌制定捆绑支付模式，以促进局部区域治疗的利用。
