Laviana Aaron A, Kundavaram Chandan R, Tan Hung-Jui, Burke Michael A, Niedzwiecki Douglas, Lee Richard K, Hu Jim C
Institute of Urologic Oncology, Department of Urology, David Geffen School of Medicine at University of California, Los Angeles, California.
Veterans Affairs/UCLA Robert Wood Johnson Clinical Scholars Program, University of California-Los Angeles Health System, Los Angeles, California.
Urol Pract. 2016 May;3(3):180-186. doi: 10.1016/j.urpr.2015.07.003. Epub 2016 Feb 12.
We report the implementation of time driven, activity based costing for competing treatments of small renal masses at an academic referral center.
To use time driven, activity based costing we developed a process map outlining the steps to treat small renal masses. We then derived the costs of supplying every resource per unit time. Known as the capacity cost rate, this included equipment and its depreciation (eg price per minute of the operating room table), personnel and space (eg cost per minute to rent clinic space). We multiplied each capacity cost rate by the time for each step. Time driven, activity based costing was defined as the sum of the products for each intervention.
Robot-assisted laparoscopic partial nephrectomy was the most expensive treatment for small renal masses. It was 69.7% more costly than the most inexpensive inpatient modality, laparoscopic radical nephrectomy ($17,841.79 vs $10,514.05). Equipment costs were greater for laparoscopic radical nephrectomy than for open partial nephrectomy. However for laparoscopic radical nephrectomy vs open partial nephrectomy the lower personnel capacity cost rate due to faster operating room time (195.2 vs 217.3 minutes, p = 0.001) and shorter length of stay (2.4 vs 3.7 days, p = 0.13) were the primary drivers in lowering costs. Radiofrequency ablation was 48.4% less expensive than laparoscopic radical nephrectomy ($5,093.83 vs $10,514.05) largely by avoiding inpatient costs. Renal biopsy contributed 3.5% vs 12.2% to the overall cost of robot-assisted laparoscopic partial nephrectomy vs radiofrequency ablation but it may allow for increased active surveillance.
Using time driven, activity based costing we determined the relative resource utilization of competing small renal mass treatments, finding significant cost differences among various treatments. This informs value considerations, which are particularly relevant in the current health care milieu.
我们报告了在一家学术转诊中心对小肾肿块的竞争性治疗采用时间驱动作业成本法的情况。
为了使用时间驱动作业成本法，我们绘制了一个流程图，概述了治疗小肾肿块的步骤。然后我们得出了每单位时间提供每种资源的成本。这被称为产能成本率，包括设备及其折旧（例如手术台每分钟的价格）、人员和空间（例如租用诊所空间每分钟的成本）。我们将每个产能成本率乘以每个步骤的时间。时间驱动作业成本法被定义为每种干预措施的乘积之和。
机器人辅助腹腔镜部分肾切除术是治疗小肾肿块最昂贵的方法。它比最便宜的住院治疗方式腹腔镜根治性肾切除术贵69.7%（17841.79美元对10514.05美元）。腹腔镜根治性肾切除术的设备成本高于开放性部分肾切除术。然而，对于腹腔镜根治性肾切除术与开放性部分肾切除术，由于手术室时间更快（195.2对217.3分钟，p = 0.001）和住院时间更短（2.4对3.7天，p = 0.13），较低的人员产能成本率是降低成本的主要驱动因素。射频消融比腹腔镜根治性肾切除术便宜48.4%（5093.83美元对10514.05美元），主要是通过避免住院成本。肾活检在机器人辅助腹腔镜部分肾切除术与射频消融的总成本中所占比例分别为3.5%和12.2%，但它可能会增加主动监测。
通过使用时间驱动作业成本法，我们确定了竞争性小肾肿块治疗的相对资源利用情况，发现各种治疗方法之间存在显著的成本差异。这为价值考量提供了信息，在当前的医疗环境中尤为相关。
