Kobeissi B J, Gupta M, Perez C A, Dopuch N, Michalski J M, Van Antwerp G, Gerber R, Wasserman T H
Mallinckrodt Institute of Radiology, Washington University Medical Center, St. Louis, MO 63108, USA.
Int J Radiat Oncol Biol Phys. 1998 Feb 1;40(3):593-603. doi: 10.1016/s0360-3016(97)00857-2.
To develop a methodology to estimate the comparative cost of physician time in treating patients with localized prostate cancer, using as an example two-dimensional (2D) vs. three-dimensional (3D) conformal irradiation techniques, and to illustrate how current cost-accounting techniques can be used to quantify the cost of physician time and effort of any treatment.
Activity-based costing, a recent innovation in accounting, widely recommended for estimating and managing the costs of specific activities, was used to derive physician resource utilization costs (actual cost of the physician services and related support services consumed).
Patients treated with 3D conformal irradiation consume about 50% more physician time than patients receiving 2D conventional radiation therapy. The average professional reimbursement for the 3D conformal irradiation is only about 26% more than for the 2D treatment. Substantial variations in cost are found depending on the total available physician working hours. In an academic institution, a physician working 40 hours a week would have to spend an average of about 60% of available time on clinical services to break even on a 2D treatment process and over 74% of available time on clinical work to break even on a 3D treatment process. The same physician working 50 hours a week would have to spend an average of about 48% of available time on 2D clinical services and about 60% of available time on 3D clinical work to break even. Current Medicare reimbursement for 3D treatment falls short of actual costs, even if physicians work 100% of a 50-hour week. Medicare reimbursement for 2D barely allows the department to break even for 2D treatments.
Costs based on estimates of resource use can be substantially under- or overestimated. A consistent language (method) is needed to obtain and describe the costs of radiation therapy. The methodology described here can help practitioners and researchers more accurately interpret actual cost information. Future use of such cost-estimation methodologies could provide consistent and comparable costs for negotiations with health care providers and help assess different treatment strategies.
开发一种方法来估算治疗局限性前列腺癌患者时医生时间的比较成本，以二维（2D）与三维（3D）适形放疗技术为例，并说明如何使用当前的成本核算技术来量化任何治疗中医生时间和精力的成本。
基于活动的成本核算，这是会计领域的一项最新创新，被广泛推荐用于估算和管理特定活动的成本，用于得出医生资源利用成本（所消耗的医生服务和相关支持服务的实际成本）。
接受3D适形放疗的患者比接受2D传统放疗的患者消耗的医生时间多约50%。3D适形放疗的平均专业报销费用仅比2D治疗高约26%。根据医生的总可用工作时间，成本存在很大差异。在一所学术机构中，一名每周工作40小时的医生在2D治疗过程中平均要将约60%的可用时间用于临床服务才能实现收支平衡，而在3D治疗过程中要将超过74%的可用时间用于临床工作才能实现收支平衡。同一名每周工作50小时的医生在2D临床服务上平均要花费约48%的可用时间，在3D临床工作上要花费约60%的可用时间才能实现收支平衡。即使医生每周工作50小时的100%，当前医疗保险对3D治疗的报销仍低于实际成本。医疗保险对2D治疗的报销仅勉强使科室在2D治疗中实现收支平衡。
基于资源使用估计的成本可能被大幅低估或高估。需要一种一致的语言（方法）来获取和描述放射治疗的成本。这里描述的方法可以帮助从业者和研究人员更准确地解释实际成本信息。未来使用这种成本估算方法可以为与医疗服务提供者的谈判提供一致且可比的成本，并有助于评估不同的治疗策略。
