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Bulman JC, Kim NH, Kaplan RS, Schroeppel DeBacker SE, Brook OR, Sarwar A. True Costs of Uterine Artery Embolization: Time-Driven Activity-Based Costing in Interventional Radiology Over a 3-Year Period. J Am Coll Radiol 2024:S1546-1440(24)00004-8. [PMID: 38220041 DOI: 10.1016/j.jacr.2024.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 12/29/2023] [Accepted: 01/05/2024] [Indexed: 01/16/2024]
Abstract
PURPOSE The aim of this study is to uncover potential areas for cost savings in uterine artery embolization (UAE) using time-driven activity-based costing, the most accurate costing methodology for direct health care system costs. METHODS One hundred twenty-three patients who underwent outpatient UAE for fibroids or adenomyosis between January 2020 and December 2022 were retrospectively reviewed. Utilization times were captured from electronic health record time stamps and staff interviews using validated techniques. Capacity cost rates were estimated using institutional data and manufacturer proxy prices. Costs were calculated using time-driven activity-based costing for personnel, equipment, and consumables. Differences in time utilization and costs between procedures by an interventional radiology attending physician only versus an interventional radiology attending physician and trainee were additionally performed. RESULTS The mean total cost of UAE was $4,267 ± $1,770, the greatest contributor being consumables (51%; $2,162 ± $811), followed by personnel (33%; $1,388 ± $340) and equipment (7%; $309 ± $96). Embolic agents accounted for the greatest proportion of consumable costs, accounting for 51% ($1,273 ± $789), followed by vascular devices (15%; $630 ± $143). The cost of embolic agents was highly variable, driven mainly by the number of vials (range 1-19) of tris-acryl gelatin particles used. Interventional radiology attending physician only cases had significantly lower personnel costs ($1,091 versus $1,425, P = .007) and equipment costs ($268 versus $317, P = .007) compared with interventional radiology attending physician and trainee cases, although there was no significant difference in mean overall costs ($3,640 versus $4,386; P = .061). CONCLUSIONS Consumables accounted for the majority of total cost of UAE, driven by the cost of embolic agents and vascular devices.
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Affiliation(s)
- Julie C Bulman
- Division Vascular and Interventional Radiology, Department of Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Massachusetts.
| | | | - Robert S Kaplan
- Fellow and Marvin Bower Professor of Leadership Development, Emeritus, Harvard Business School, Boston, Massachusetts
| | - Sarah E Schroeppel DeBacker
- Division Vascular and Interventional Radiology, Department of Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Massachusetts
| | - Olga R Brook
- Section Chief of Abdominal Radiology, Vice Chair of Research, Division Abdominal Radiology, Department of Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Massachusetts
| | - Ammar Sarwar
- Chair of Economics, Society of Interventional Radiology, Division Vascular and Interventional Radiology, Department of Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Massachusetts
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Iachecen F, Dallagassa MR, Portela Santos EA, Carvalho DR, Ioshii SO. Is it possible to automate the discovery of process maps for the time-driven activity-based costing method? A systematic review. BMC Health Serv Res 2023; 23:1408. [PMID: 38093275 PMCID: PMC10720189 DOI: 10.1186/s12913-023-10411-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 11/30/2023] [Indexed: 12/17/2023] Open
Abstract
OBJECTIVES The main objective of this manuscript was to identify the methods used to create process maps for care pathways that utilized the time-driven activity-based costing method. METHODS This is a systematic mapping review. Searches were performed in the Embase, PubMed, CINAHL, Scopus, and Web of Science electronic literature databases from 2004 to September 25, 2022. The included studies reported practical cases from healthcare institutions in all medical fields as long as the time-driven activity-based costing method was employed. We used the time-driven activity-based costing method and analyzed the created process maps and a qualitative approach to identify the main fields. RESULTS A total of 412 studies were retrieved, and 70 articles were included. Most of the articles are related to the fields of orthopedics and childbirth-related to hospital surgical procedures. We also identified various studies in the field of oncology and telemedicine services. The main methods for creating the process maps were direct observational practices, complemented by the involvement of multidisciplinary teams through surveys and interviews. Only 33% of the studies used hospital documents or healthcare data records to integrate with the process maps, and in 67% of the studies, the created maps were not validated by specialists. CONCLUSIONS The application of process mining techniques effectively automates models generated through clinical pathways. They are applied to the time-driven activity-based costing method, making the process more agile and contributing to the visualization of high degrees of variations encountered in processes, thereby making it possible to enhance and achieve continual improvements in processes.
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Affiliation(s)
- Franciele Iachecen
- Graduate Program in Health Technology, Pontifícia Universidade Católica do Paraná., 1155, Imaculada Conceição st., Curitiba, Paraná, 80215-90, Brazil.
| | - Marcelo Rosano Dallagassa
- Graduate Program in Health Technology, Pontifícia Universidade Católica do Paraná., 1155, Imaculada Conceição st., Curitiba, Paraná, 80215-90, Brazil
| | | | - Deborah Ribeiro Carvalho
- Graduate Program in Health Technology, Pontifícia Universidade Católica do Paraná., 1155, Imaculada Conceição st., Curitiba, Paraná, 80215-90, Brazil
| | - Sérgio Ossamu Ioshii
- Graduate Program in Health Technology, Pontifícia Universidade Católica do Paraná., 1155, Imaculada Conceição st., Curitiba, Paraná, 80215-90, Brazil
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Beck da Silva Etges AP, de Lara LR, Sapper SL, Frankenberg Berger AV, Streck M, Zardo L, Linhares A, Nassif M, Zanotto A, Pereira Lima MN, Vargas R, Polanczyk CA. Redesign of radiotherapy for prostate cancer: a proposal for universal healthcare systems. J Comp Eff Res 2023; 12:e230023. [PMID: 37916706 PMCID: PMC10734317 DOI: 10.57264/cer-2023-0023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 10/23/2023] [Indexed: 11/03/2023] Open
Abstract
Aim: This study was designed to recommend strategies to improve prostate patients' access to radiotherapy treatment in the Brazilian Unified Health System, along with a cost-tool to support radiotherapy care pathways' lead times and costs. Methods: Data was collected prospectively from patients with prostate cancer receiving radiotherapy in two Brazilian centers to provide data to apply design thinking and process reengineering techniques. The current status of the radiotherapy pathway was determined and the length of time taken for in-hospital activities was measured using data exported from ARIA®. Interviews with patients were used to estimate their waiting periods. This provided the data used to provide recommended strategies and the cost tool based on time-driven activity-based costing. The strategies were classified according to priority. Results: Data from 47 patients were analyzed. The mean interval from diagnosis to start of radiotherapy was 349 days (SD581), and the mean interval from seeking medical attention to starting treatment was 635 days (SD629). Twelve strategies affecting in-hospital processes and 11 impacting patients' care pathways and experiences are recommended, mostly focused on system improvement opportunities. A time-driven activity-based costing monitoring using data extracted from ARIA was coded and can be used by centers as a cost assessment guide. Conclusion: This study uses reengineering and design techniques to introduce priority strategies to allow more efficient and patient-centered radiotherapy.
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Affiliation(s)
- Ana Paula Beck da Silva Etges
- National Institute of Science & Technology for Health Technology Assessment (IATS) – CNPq/Brazil (project: 465518/2014-1), Porto Alegre, 90035-903, Brazil
- Avant-garde Health, Boston, MA 02111, USA
- Graduate Program in Epidemiology, Universidade Federal do Rio Grande do Sul School of Medicine, Porto Alegre, RS, 90035-002, Brazil
| | - Luciana Rodrigues de Lara
- National Institute of Science & Technology for Health Technology Assessment (IATS) – CNPq/Brazil (project: 465518/2014-1), Porto Alegre, 90035-903, Brazil
| | - Stella Lisboa Sapper
- Crialab, Tecnopuc, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, 90619-900, Brazil
| | - Ana Von Frankenberg Berger
- Crialab, Tecnopuc, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, 90619-900, Brazil
| | - Melissa Streck
- Crialab, Tecnopuc, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, 90619-900, Brazil
| | - Laise Zardo
- Hospital Santa Rita, Irmandade da Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, RS, 90020-090, Brazil
| | - Armani Linhares
- Department of Internal Medicine, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, 90619-900, Brazil
- Medicine course, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Porto Alegre, RS, 90050-170, Brazil
| | - Marina Nassif
- Universidade Federal do Rio Grande do Sul School of Medicine, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, 90619-900, Brazil
| | - Angélica Zanotto
- National Institute of Science & Technology for Health Technology Assessment (IATS) – CNPq/Brazil (project: 465518/2014-1), Porto Alegre, 90035-903, Brazil
| | - Marta Nassif Pereira Lima
- Universidade Federal do Rio Grande do Sul School of Medicine, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, 90619-900, Brazil
| | - Rafael Vargas
- National Institute of Science & Technology for Health Technology Assessment (IATS) – CNPq/Brazil (project: 465518/2014-1), Porto Alegre, 90035-903, Brazil
- Department of Internal Medicine, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, 90619-900, Brazil
- Hospital Santa Rita, Irmandade da Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, RS, 90020-090, Brazil
| | - Carisi Anne Polanczyk
- National Institute of Science & Technology for Health Technology Assessment (IATS) – CNPq/Brazil (project: 465518/2014-1), Porto Alegre, 90035-903, Brazil
- Graduate Program in Epidemiology, Universidade Federal do Rio Grande do Sul School of Medicine, Porto Alegre, RS, 90035-002, Brazil
- Universidade Federal do Rio Grande do Sul School of Medicine, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, 90619-900, Brazil
- Hospital Moinhos de Vento, Porto Alegre, RS, 90035-000, Brazil
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van Steenbergen GJ, Schulz DN, Slingerland SR, Tonino PA, Soliman-Hamad MA, Dekker L, van Veghel D. Introduction of a New Method to Monitor Patient-Relevant Outcomes and Costs: Using a Quality Improvement Project in Transcatheter Aortic Valve Implantation Care as an Example. Qual Manag Health Care 2023; 32:247-256. [PMID: 36940366 DOI: 10.1097/qmh.0000000000000401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2023]
Abstract
BACKGROUND AND OBJECTIVE Routine outcome monitoring is becoming standard in care evaluations, but costs are still underrepresented in these efforts. The primary aim of this study was therefore to assess if patient-relevant cost drivers can be used alongside clinical outcomes to evaluate an improvement project and to provide insight into (remaining) areas for improvement. METHODS Data from patients who underwent transcatheter aortic valve implantation (TAVI) between 2013 and 2018 at a single center in the Netherlands were used. A quality improvement strategy was implemented in October 2015, and pre- (A) and post-quality improvement cohorts (B) were distinguished. For each cohort, clinical outcomes, quality of life (QoL), and cost drivers were collected from the national cardiac registry and hospital registration data. The most appropriate cost drivers in TAVI care were selected from hospital registration data using a novel stepwise approach with an expert panel of physicians, managers, and patient representatives. A radar chart was used to visualize the clinical outcomes, QoL and the selected costs drivers. RESULTS We included 81 patients in cohort A and 136 patients in cohort B. All-cause mortality at 30 days was borderline significantly lower in cohort B than in cohort A (1.5% vs 7.4%, P = .055). QoL improved after TAVI for both cohorts. The stepwise approach resulted in 21 patient-relevant cost drivers. Costs for pre-procedural outpatient clinic visits (€535, interquartile range [IQR] = 321-675, vs €650, IQR = 512-890, P < .001), costs for the procedure (€1354, IQR = 1236-1686, vs €1474, IQR = 1372-1620, P < .001), and imaging during admission (€318, IQR = 174-441, vs €329, IQR = 267-682, P = .002) were significantly lower in cohort B than in cohort A. Possible improvement potential was seen in 30-day pacemaker implantation and 120-day readmission. CONCLUSION A selection of patient-relevant cost drivers is a valuable addition to clinical outcomes for use in evaluation of improvement projects and identification of room for further improvement.
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Affiliation(s)
- Gijs J van Steenbergen
- Catharina Heart Centre, Catharina Hospital, Eindhoven, the Netherlands (Drs van Steenbergen, Schulz, Tonino, Soliman-Hamad, Dekker, and van Veghel and Ms Slingerland); and Department of Biomedical Technology, Eindhoven University of Technology, Eindhoven, the Netherlands (Dr Dekker)
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Katano S, Yano T, Numazawa R, Nagaoka R, Yamano K, Fujisawa Y, Honma S, Watanabe A, Ohori K, Kouzu H, Fujito T, Ishigo T, Kunihara H, Fujisaki H, Katayose M, Hashimoto A, Furuhashi M. Impact of Radar Chart-Based Information Sharing in a Multidisciplinary Team on In-Hospital Outcomes and Prognosis in Older Patients With Heart Failure. Circ Rep 2023; 5:271-281. [PMID: 37431515 PMCID: PMC10329901 DOI: 10.1253/circrep.cr-23-0049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 05/18/2023] [Indexed: 07/12/2023] Open
Abstract
Background: A multidisciplinary team (MDT) approach is crucial for managing older patients with heart failure (HF). We investigated the impact on clinical outcomes of implementation of a conference sheet (CS) with an 8-component radar chart for visualizing and sharing patient information. Methods and Results: We enrolled 395 older inpatients with HF (median age 79 years [interquartile range 72-85 years]; 47% women) and divided them into 2 groups according to CS implementation: a non-CS group (before CS implementation; n=145) and a CS group (after CS implementation; n=250). The clinical characteristics of patients in the CS group were assessed using 8 scales (physical function, functional status, comorbidities, nutritional status, medication adherence, cognitive function, HF knowledge level, and home care level). In-hospital outcomes (Short Physical Performance Battery, Barthel Index score, length of hospital stay, and hospital transfer rate) were significantly better in the CS than non-CS group. During the follow-up period, 112 patients experienced composite events (all-cause death or admission for HF). Inverse probabilities of treatment-weighted Cox proportional hazard analyses demonstrated a 39% reduction in risk of composite events in the CS group (adjusted hazard ratio 0.65; 95% confidence interval 0.43-0.97). Conclusions: Radar chart-based information sharing among MDT members is associated with superior in-hospital clinical outcomes and a favorable prognosis.
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Affiliation(s)
- Satoshi Katano
- Division of Rehabilitation, Sapporo Medical University Hospital Sapporo Japan
- Second Division of Physical Therapy, Sapporo Medical University School of Health Science Sapporo Japan
| | - Toshiyuki Yano
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine Sapporo Japan
| | - Ryo Numazawa
- Graduate School of Medicine, Sapporo Medical University Sapporo Japan
| | - Ryohei Nagaoka
- Division of Rehabilitation, Sapporo Medical University Hospital Sapporo Japan
| | - Kotaro Yamano
- Department of Rehabilitation, Teine Keijinkai Hospital Sapporo Japan
| | - Yusuke Fujisawa
- Department of Rehabilitation, Japanese Red Cross Asahikawa Hospital Asahikawa Japan
| | - Suguru Honma
- Second Division of Physical Therapy, Sapporo Medical University School of Health Science Sapporo Japan
- Department of Rehabilitation, Sapporo Cardiovascular Hospital Sapporo Japan
| | - Ayako Watanabe
- Division of Nursing, Sapporo Medical University Hospital Sapporo Japan
| | - Katsuhiko Ohori
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine Sapporo Japan
- Department of Cardiology, Hokkaido Cardiovascular Hospital Sapporo Japan
| | - Hidemichi Kouzu
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine Sapporo Japan
| | - Takefumi Fujito
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine Sapporo Japan
| | - Tomoyuki Ishigo
- Division of Hospital Pharmacy, Sapporo Medical University Hospital Sapporo Japan
| | - Hayato Kunihara
- Division of Rehabilitation, Sapporo Medical University Hospital Sapporo Japan
| | - Hiroya Fujisaki
- Division of Rehabilitation, Sapporo Medical University Hospital Sapporo Japan
| | - Masaki Katayose
- Second Division of Physical Therapy, Sapporo Medical University School of Health Science Sapporo Japan
| | - Akiyoshi Hashimoto
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine Sapporo Japan
- Division of Health Care Administration and Management, Sapporo Medical University School of Medicine Sapporo Japan
| | - Masato Furuhashi
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine Sapporo Japan
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Allen CJ, Smith GL, Prakash L, Volk RJ, Ikoma N, Aloia TA, Gottumukkala V, Katz MHG. What is "Value"? Results of a Survey of Cancer Patients and Providers. Ann Surg Oncol 2022; 29:6537-6545. [PMID: 35391609 DOI: 10.1245/s10434-022-11534-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 01/16/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND We measured the importance patients with gastrointestinal cancer and health care providers place on treatment outcomes, quality of life, and costs. METHODS This cross-sectional survey study was conducted between June 1, 2020 and November 30, 2020. We identified surviving patients who had been treated or were anticipating treatment for pancreatic or gastric cancer at our single institution from January 1, 2000 through January 31, 2020. Surveys assessed the importance patients and providers placed on outcomes, well-being, costs, and experiences. Surveys measured how these values had changed over time. We compared the importance patients and providers place on each of the attributes of value. RESULTS A total of 383 patients and 164 providers responded. Providers felt experience, emotional well-being, and costs were more important than patients themselves did (all p < 0.05). Patients more commonly reported that survival had become more important to them over time, while providers believed that emotional well-being, experience, and costs had become more important to patients (all p < 0.05). Postoperative patients ranked functional well-being as more important than preoperative patients did (p = 0.031). Patients of lower income and education levels more reported concerns of costs over the course of their care (both p < 0.05). Younger age was associated with concern for direct (r = -0.167, p = 0.004) and indirect costs (r = -0.318, p < 0.001). CONCLUSIONS Although there are consistencies amongst the views of cancer patients and providers, there remain discordances in the perception of value. Patients' values differed across their treatment and survivorship course. These data demonstrate the importance of accounting for multistakeholder perspectives in assessments of value in health care.
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Affiliation(s)
- Casey J Allen
- Department of Surgery, Division of Surgical Oncology, Allegheny Health Network, Pittsburgh, PA, USA
| | - Grace L Smith
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Laura Prakash
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Robert J Volk
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Naruhiko Ikoma
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Vijaya Gottumukkala
- The Institute for Cancer Care Innovation, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Department of Anesthesiology & Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Matthew H G Katz
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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Lee JJB, Lee E, Choi WH, Kim J, Chang KH, Kim DW, Shin HB, Kim TH, Byun HK, Cho J. Dosimetric outcomes of preoperative treatment planning with intraoperative optimization using stranded seeds in prostate brachytherapy. PLoS One 2022; 17:e0265143. [PMID: 35353847 PMCID: PMC8967021 DOI: 10.1371/journal.pone.0265143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 02/23/2022] [Indexed: 11/18/2022] Open
Abstract
This study aimed to evaluate the quality of low-dose-rate (LDR) prostate brachytherapy (BT) based on treatment-related dosimetric outcomes. Data of 100 patients treated using LDR BT with stranded seeds from November 2012 to November 2017 were collected. The prescription dose for the prostate was 145 Gy. The dose constraints for the preoperative plan were: V100% ≥ 95%, V150% ≤ 60%, V200% ≤ 20% for the prostate; V100% for rectum, ≤ 1 cc; and V200 Gy for urethra, 0.0 cc. Intraoperative real-time dose calculation and postoperative dose distribution analysis on days 0 and 30 were performed. Median dosimetric outcomes on days 0 and 30 respective were: V100% 92.28% and 92.23%, V200% 18.63% and 25.02%, and D90% 150.88 Gy and 151.46 Gy for the prostate; V100% for the rectum, 0.11 cc and 0.22 cc; and V200 Gy for the urethra, 0.00 cc and 0.00 cc, respectively. Twenty patients underwent additional seed implantation to compensate for insufficient dose coverage of the prostate. No loss or substantial migration of seeds or severe toxicity was reported. With stranded seed implantation and intraoperative optimization, appropriate dose delivery to the prostate without excessive dose to the organs at risk could be achieved.
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Affiliation(s)
- Jason Joon Bock Lee
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
- Department of Radiation Oncology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Eungman Lee
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
- Department of Radiation Oncology, Ewha Womans University College of Medicine, Seoul, South Korea
| | | | - Jihun Kim
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
| | - Kyung Hwan Chang
- Department of Digital Health Solution, Douzone Bizon, Seoul, South Korea
| | - Dong Wook Kim
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
| | - Han Back Shin
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
| | - Tae Hyung Kim
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
- Department of Radiation Oncology, Nowon Eulji Medical Center, Seoul, South Korea
| | - Hwa Kyung Byun
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
| | - Jaeho Cho
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
- * E-mail:
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Kamrava M, Thaker N, Small W, Frank SJ. Driving accountable care with brachytherapy. Brachytherapy 2021; 21:4-5. [PMID: 34930712 DOI: 10.1016/j.brachy.2021.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 10/25/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Mitchell Kamrava
- Cedars Sinai Medical Center, Department of Radiation Oncology, Los Angeles, CA.
| | | | - William Small
- Loyola University Chicago, Stritch School of Medicine, Department of Radiation Oncology, Cardinal Bernardin Cancer Center, Maywood, IL
| | - Steven J Frank
- MD Anderson Cancer Center, Department of Radiation Oncology, Houston, TX
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Mantz CA, Thaker NG, Pendyala P, Hubbard A, Eichler TJ, Shah C, Orio PF, Petereit DG. Disproportionate Negative Impact of the Radiation Oncology Alternative Payment Model on Rural Providers: A Cost Identification Analysis of Medicare Claims. JCO Oncol Pract 2021; 17:e1977-e1983. [PMID: 34529516 DOI: 10.1200/op.21.00330] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE The Radiation Oncology Alternative Payment Model (APM) is a Medicare demonstration project that will test whether prospective bundled payments to a randomly selected group of physician practices, hospital outpatient departments, and freestanding radiation therapy centers reduce overall expenditures while preserving or enhancing the quality of care for beneficiaries. The Model follows a complicated pricing methodology that blends historical reimbursements for a defined set of services made to professional and technical providers to create a weighted payment average for each of 16 cancer types. These averages are then adjusted by various factors to determine APM payments specific to each participating provider. METHODS This impact study segregates APM participants into rural and urban groups and analyzes the effect of the Radiation Oncology Alternative Payment Model on their fee-for-service reimbursements. RESULTS The main findings of this study are (1) the greater net-negative revenue impact on rural facilities versus urban facilities that would have participated in the Model this year and (2) the relative lack of high-value treatment services (ie, stereotactic radiotherapy and brachytherapy) delivered by rural facilities that exacerbates their negative impact. CONCLUSION As such, rural providers participating in the Model in its current form may face greater risk to their economic viability and greater difficulty in funding technology improvements necessary for the achievement of high-quality care compared with their urban counterparts.
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Affiliation(s)
| | | | | | - Anne Hubbard
- American Society for Radiation Oncology, Fairfax, VA
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10
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McClintock TR, Friedlander DF, Feng AY, Shah MA, Pallin DJ, Chang SL, Bader AM, Feeley TW, Kaplan RS, Haleblian GE. Determining variable costs in the acute urolithiasis cycle of care through time-driven activity-based costing. Urology 2021; 157:107-113. [PMID: 34391774 DOI: 10.1016/j.urology.2021.05.102] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 05/03/2021] [Accepted: 05/12/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To characterize full cycle of care costs for managing an acute ureteral stone using time-driven activity-based costing. METHODS We defined all phases of care for patients presenting with an acute ureteral stone and built an overarching process map. Maps for sub-processes were constructed through interviews with providers and direct observation of clinical spaces. This facilitated calculation of cost per minute for all aspects of care delivery, which were multiplied by associated process times. These were added to consumable costs to determine cost for each specific step and later aggregated to determine total cost for each sub-process. We compared costs of eight common clinical pathways for acute stone management, defining total cycle of care cost as the sum of all sub-processes that comprised each pathway. RESULTS Cost per sub-process included $920 for emergency department (ED) care, $1665 for operative stent placement, $2368 for percutaneous nephrostomy tube placement, $106 for urology clinic consultation, $238 for preoperative center visit, $4057 for ureteroscopy with laser lithotripsy (URS), $2923 for extracorporeal shock wave lithotripsy, $169 for clinic stent removal, $197 for abdominal x-ray, and $166 for ultrasound. The lowest cost pathway ($1388) was for medical expulsive therapy, whereas the most expensive pathway ($8002) entailed a repeat ED visit prompting temporizing stent placement and interval URS. CONCLUSION We found a high degree of cost variation between care pathways common to management of acute ureteral stone episodes. Reliable cost accounting data and an understanding of variability in clinical pathway costs can inform value-based care redesign as payors move away from pure fee-for-service reimbursement.
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Affiliation(s)
- Tyler R McClintock
- Division of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Division of Urology, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA; Harvard Business School, Boston, MA.
| | - David F Friedlander
- Division of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Aiden Y Feng
- Department of Anesthesiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | | | - Daniel J Pallin
- Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Steven L Chang
- Division of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Angela M Bader
- Department of Anesthesiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Thomas W Feeley
- Harvard Business School, Boston, MA; The Institute for Cancer Care Innovation and Division of Anesthesiology and Critical Care, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - George E Haleblian
- Division of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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11
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Thaker NG, Kudchadker RJ, Incalcaterra JR, Bathala TK, Kaplan RS, Agarwal A, Kuban DA, Frank BD, Das P, Feeley TW, Frank SJ. Improving efficiency and reducing costs of MRI-Guided prostate brachytherapy using Time-Driven Activity-Based costing. Brachytherapy 2021; 21:49-54. [PMID: 34389265 DOI: 10.1016/j.brachy.2021.05.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 05/15/2021] [Accepted: 05/21/2021] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Integrated quality improvement (QI) and cost reduction strategies can help increase value in cancer care. Time-driven activity-based costing (TDABC) is a bottom-up costing tool that measures resource use over the full care cycle. We applied standard QI and TDABC methods to improve workflow efficiency and reduce costs for MRI-guided prostate brachytherapy. METHODS AND MATERIALS We constructed process maps of the baseline prostate brachytherapy workflow from initial consultation through one year after treatment. Process maps reflected resources and time required at each step. TDABC costs were calculated by multiplying each process time by the cost per min of the resource(s) used at that step. We then used plan-do-study-act methodology to identify workflow inefficiencies and implement solutions to reduce resource consumption. RESULTS The highest cost components at baseline were the operating room (OR) (40%), imaging (8.7%), and consultation (7.6%). Higher-than-expected costs (3%) were incurred during surgery scheduling. After targeted QI initiatives, OR time was reduced from 90 to 70 min, which reduced overall cost by 5%. Personnel task downshifting reduced costs by 10% at consultation and 77% at surgery scheduling. Re-engineering of follow-up protocols reduced costs by 8.4%. Costs under the new workflow decreased by 18.2%. CONCLUSIONS TDABC complements traditional QI initiatives by quantifying the highest cost steps and focusing QI initiatives to reduce costs and improve efficiency. As payment reform evolves toward bundled payments, TDABC and QI initiatives will help providers understand, communicate, and improve the value of cancer care.
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Affiliation(s)
- Nikhil G Thaker
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX; Division of Radiation Oncology, Arizona Oncology, The US Oncology Network, Tucson, AZ
| | - Rajat J Kudchadker
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - James R Incalcaterra
- The Institute for Cancer Care Innovation, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | - Ankit Agarwal
- Department of Radiation Oncology, The University of North Carolina, Chapel Hill, NC
| | - Deborah A Kuban
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Prajnan Das
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Steven J Frank
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX.
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12
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Zanotto BS, Etges APBDS, Marcolino MAZ, Polanczyk CA. Value-Based Healthcare Initiatives in Practice: A Systematic Review. J Healthc Manag 2021; 66:340-365. [PMID: 34192716 PMCID: PMC8423138 DOI: 10.1097/jhm-d-20-00283] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
EXECUTIVE SUMMARY Value-based initiatives are growing in importance as strategic models of healthcare management, prompting the need for an in-depth exploration of their outcome measures. This systematic review aimed to identify measures that are being used in the application of the value agenda. Multiple electronic databases (PubMed/MEDLINE, Embase, Scopus, Cochrane Central Register of Controlled Trials) were searched. Eligible studies reported various implementations of value-based healthcare initiatives. A qualitative approach was used to analyze their outcome measurements. Outcomes were classified according to a tier-level hierarchy. In a radar chart, we compared literature to cases from Harvard Business Publishing. The value agenda effect reported was described in terms of its impact on each domain of the value equation. A total of 7,195 records were retrieved; 47 studies were included. Forty studies used electronic health record systems for data origin. Only 16 used patient-reported outcome surveys to cover outcome tiers that are important to patients, and 3 reported outcomes to all 6 levels of our outcome measures hierarchy. A considerable proportion of the studies (36%) reported results that contributed to value-based financial outcomes focused on cost savings. However, a gap remains in measuring outcomes that matter to patients. A more complete application of the value agenda by health organizations requires advances in technology and culture change management.
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Affiliation(s)
- Bruna Stella Zanotto
- National Institute of Health Technology Assessment and Graduate Program in Epidemiology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Ana Paula Beck da Silva Etges
- National Institute of Health Technology Assessment, Federal University of Rio Grande do Sul, and Pontifical Catholic University of Rio Grande do Sul Polytechnic School, Porto Alegre, Brazil
| | - Miriam Allein Zago Marcolino
- National Institute of Health Technology Assessment, Federal University of Rio Grande do Sul and Graduate Program in Epidemiology, Federal University of Rio Grande do Sul; and
| | - Carisi Anne Polanczyk
- National Institute of Health Technology Assessment, Federal University of Rio Grande do Sul, and Graduate Programs in Epidemiology and Cardiology and Cardiovascular Sciences, Federal University of Rio Grande do Sul
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13
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Ljuboja D, Ahmed M, Ali A, Perez E, Subrize MW, Kaplan RS, Sarwar A. Time-Driven Activity-Based Costing in Interventional Oncology: Cost Measurement and Cost Variability for Hepatocellular Carcinoma Therapies. J Am Coll Radiol 2021; 18:1095-1105. [PMID: 33939974 DOI: 10.1016/j.jacr.2021.03.027] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 03/24/2021] [Accepted: 03/28/2021] [Indexed: 01/09/2023]
Abstract
PURPOSE To use time-drive activity-based costing (TDABC) to characterize and compare costs of transarterial chemoembolization (TACE), transarterial radioembolization (TARE), and ablation. METHODS 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. RESULTS 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. CONCLUSION 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.
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Affiliation(s)
- Damir Ljuboja
- 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.
| | - Muneeb Ahmed
- Chief, Division of Vascular and Interventional Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Massachusetts
| | - Aamir Ali
- Department of Radiology, Division of Vascular and Interventional Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Massachusetts
| | - Enio Perez
- Harvard School of Public Health, Boston, Massachusetts
| | - Michael W Subrize
- Department of Radiology, Division of Vascular and Interventional Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Massachusetts
| | - Robert S Kaplan
- Senior Fellow and Marvin Bower Professor of Leadership Development, Emeritus at the Harvard Business School, Boston, Massachusetts
| | - Ammar Sarwar
- Co-Director Liver Tumor Program, Division of Vascular and Interventional Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Massachusetts
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Ning MS, Venkatesan AM, Stafford RJ, Bui TP, Carlson R, Bailard NS, Vedam S, Davis R, Olivieri ND, Guzman AB, Incalcaterra JR, McKelvey FA, Thaker NG, Rauch GM, Tang C, Frank SJ, Joyner MM, Lin LL, Jhingran A, Eifel PJ, Klopp AH. Developing an intraoperative 3T MRI-guided brachytherapy program within a diagnostic imaging suite: Methods, process workflow, and value-based analysis. Brachytherapy 2020; 19:427-437. [DOI: 10.1016/j.brachy.2019.09.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 09/11/2019] [Accepted: 09/21/2019] [Indexed: 12/22/2022]
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15
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Clinical utility and value contribution of an MRI-positive line marker for image-guided brachytherapy in gynecologic malignancies. Brachytherapy 2020; 19:305-315. [DOI: 10.1016/j.brachy.2019.12.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 11/29/2019] [Accepted: 12/30/2019] [Indexed: 01/19/2023]
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16
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Boyce-Fappiano D, Ning MS, Thaker NG, Pezzi TA, Gjyshi O, Mesko S, Anakwenze C, Olivieri ND, Guzman AB, Incalcaterra JR, Tang C, McAleer MF, Herman J, Ghia AJ. Time-Driven, Activity-Based Cost Analysis of Radiation Treatment Options for Spinal Metastases. JCO Oncol Pract 2020; 16:e271-e279. [DOI: 10.1200/jop.19.00480] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE: Several treatment options for spinal metastases exist, including multiple radiation therapy (RT) techniques: three-dimensional (3D) conventional RT (3D-RT), intensity-modulated RT (IMRT), and spine stereotactic radiosurgery (SSRS). Although data exist regarding reimbursement differences across regimens, differences in provider care delivery costs have yet to be evaluated. We quantified institutional costs associated with RT for spinal metastases, using a time-driven activity-based costing model. METHODS: Comparisons were made between (1) 10-fraction 3D-RT to 30 Gy, (2) 10-fraction IMRT to 30 Gy, (3) 3-fraction SSRS (SSRS-3) to 27 Gy, and (4) single-fraction SSRS (SSRS-1) to 18 Gy. Process maps were developed from consultation through follow-up 30 days post-treatment. Process times were determined through panel interviews, and personnel costs were extracted from institutional salary data. The capacity cost rate was determined for each resource, then multiplied by activity time to calculate costs, which were summed to determine total cost. RESULTS: Full-cycle costs of SSRS-1 were 17% lower and 17% higher compared with IMRT and 3D-RT, respectively. Full-cycle costs for SSRS-3 were only 1% greater than 10-fraction IMRT. Technical costs for IMRT were 50% and 77% more than SSRS-3 and SSRS-1. In contrast, personnel costs were 3% and 28% higher for SSRS-1 than IMRT and 3D-RT, respectively ( P < .001). CONCLUSIONS: Resource utilization varies significantly among treatment options. By quantifying provider care delivery costs, this analysis supports the institutional resource efficiency of SSRS-1. Incorporating clinical outcomes with such resource and cost data will provide additional insight into the highest value modalities and may inform alternative payment models, operational workflows, and institutional resource allocation.
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Affiliation(s)
| | - Matthew S. Ning
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Todd A. Pezzi
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Olsi Gjyshi
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Shane Mesko
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | | | | | - Chad Tang
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Mary F. McAleer
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Joseph Herman
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Amol J. Ghia
- The University of Texas MD Anderson Cancer Center, Houston, TX
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17
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Ning MS, Klopp AH, Jhingran A, Lin LL, Eifel PJ, Vedam S, Lawyer AA, Olivieri ND, Guzman AB, Incalcaterra JR, Mesko SM, Pezzi TA, Boyce-Fappiano DR, Shaitelman SF, Frank SJ, Thaker NG. Quantifying institutional resource utilization of adjuvant brachytherapy and intensity-modulated radiation therapy for endometrial cancer via time-driven activity-based costing. Brachytherapy 2019; 18:445-452. [DOI: 10.1016/j.brachy.2019.03.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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18
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Dess RT, Soni PD, Jackson WC, Berlin A, Cox BW, Jolly S, Efstathiou JA, Feng FY, Kishan AU, Stish BJ, Pisansky TM, Spratt DE. The current state of randomized clinical trial evidence for prostate brachytherapy. Urol Oncol 2019; 37:599-610. [PMID: 31060795 DOI: 10.1016/j.urolonc.2019.04.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 03/26/2019] [Accepted: 04/09/2019] [Indexed: 02/06/2023]
Abstract
Interstitial brachytherapy is one of several curative therapeutic options for the treatment of localized prostate cancer. In this review, we summarize all available randomized data to support the optimal use of prostate brachytherapy. Evidence from completed randomized controlled trials is the focus of this review with a presentation also of important ongoing trials. Gaps in knowledge are identified where future investigation may be fruitful with intent to inspire well-designed prospective studies with standardized treatment that focuses on improving oncological outcomes, reducing morbidity, or maintaining quality of life.
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Affiliation(s)
- Robert T Dess
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI.
| | - Payal D Soni
- Department of Radiation Oncology, Hunter Holmes McGuire VA Medical Center, Richmond, VA
| | - William C Jackson
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI
| | - Alejandro Berlin
- Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Brett W Cox
- Department of Radiation Medicine, Northwell Health, Hofstra Northwell School of Medicine, Hempstead, NY
| | - Shruti Jolly
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI
| | - Jason A Efstathiou
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA
| | - Felix Y Feng
- Departments of Radiation Oncology, Urology and Medicine, University of California San Francisco, San Francisco, CA
| | - Amar U Kishan
- Department of Radiation Oncology, University of California Los Angeles, Los Angeles, CA
| | - Bradley J Stish
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
| | | | - Daniel E Spratt
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI
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19
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Prostate Brachytherapy: Clinical Efficacy and Future Trends. Brachytherapy 2019. [DOI: 10.1007/978-981-13-0490-3_10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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20
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Cost in perspective: direct assessment of American market acceptability of Co-60 in gynecologic high-dose-rate brachytherapy and contrast with experience abroad. J Contemp Brachytherapy 2018; 10:503-509. [PMID: 30662472 PMCID: PMC6335552 DOI: 10.5114/jcb.2018.79928] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 11/03/2018] [Indexed: 11/17/2022] Open
Abstract
Purpose While Ir-192 remains the mainstay isotope for gynecologic high-dose-rate (HDR) brachytherapy in the U.S., Co-60 is used abroad. Co-60 has a longer half-life than Ir-192, which may lead to long-term cost savings; however, its higher energy requires greater shielding. This study analyzes Co-60 acceptability based on a one-time expense of additional shielding and reports the financial experience of Co-60 in Peru’s National Cancer Institute, which uses both isotopes. Material and methods A nationwide survey was undertaken assessing physician knowledge of Co-60 and willingness-to-pay (WTP) for additional shielding, assuming a source more cost-effective than Ir-192 was available. With 440 respondents, 280 clinicians were decision-makers and provided WTPs, with results previously reported. After completing a shielding report, we estimated costs for shielding expansion, noting acceptability to decision makers’ WTP. Using activity-based costing, we note the Peruvian fiscal experience. Results Shielding estimates ranged from $173,000 to $418,000. The percentage of respondents accepting high-density modular or lead shielding (for union and non-union settings) were 17.5%, 11.4%, 3.9%, and 3.2%, respectively. Shielding acceptance was associated with greater number of radiation oncologists in a respondent’s department but not time in practice or the American Brachytherapy Society membership. Peru’s experience noted cost savings with Co-60 of $52,400 annually. Conclusions By comparing the cost of additional shielding for a sample institution’s HDR suite with radiation oncologists’ WTP, this multi-institutional collaboration noted < 20% of clinicians would accept additional shielding. Despite low acceptability in the US, Co-60 demonstrates cost-favorability in Peru and may similarly in other locations.
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Orio PF, Goodwin J. In Regard to Bauer-Nilsen et al. Int J Radiat Oncol Biol Phys 2018; 102:1598-1599. [DOI: 10.1016/j.ijrobp.2018.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 07/03/2018] [Accepted: 08/01/2018] [Indexed: 10/27/2022]
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22
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Alves RJV, Etges APBDS, Neto GB, Polanczyk CA. Activity-Based Costing and Time-Driven Activity-Based Costing for Assessing the Costs of Cancer Prevention, Diagnosis, and Treatment: A Systematic Review of the Literature. Value Health Reg Issues 2018; 17:142-147. [PMID: 30149318 DOI: 10.1016/j.vhri.2018.06.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2017] [Revised: 04/29/2018] [Accepted: 06/04/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND A review of the literature on economic analyses in cancer (prevention, diagnosis, and treatment) using activity-based costing (ABC) or time-driven activity-based costing (TDABC) for measuring costs and to examine how these approaches have been applied to assess and manage cancer costs. METHODS This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. We conducted a search for studies that used ABC or TDABC to calculate the cost of cancer in prevention, diagnosis, and treatment. Only English- and Portuguese-language articles were retrieved from Medline, Lilacs, ScieLO, and Embase (January 1990 to August 2016). RESULTS In total, 421 studies were evaluated. However, only 27 papers were included. The first publications were from the early 2000s, but most of the studies were published in 2016 (n = 10). Most of the studies were carried out in the United States (n = 6) and Belgium (n = 6). Cancer treatment was the major focus of all studies (n = 20), followed by screening programs evaluations (n = 4) and diagnosis (n = 3). Among treatment modalities, economic analysis of radiotherapy was the most common topic of study. Retrospective clinical data represented 57.6% of the studies. More than 50% of the studies presented unspecified economic analysis. The hospital perspective was the most prevalent perspective among the studies (46.1%). CONCLUSIONS ABC and TDABC economic analyses are a promising area of studies in oncology costs.
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Affiliation(s)
- Rafael J Vargas Alves
- Graduate Program of Epidemiology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil.
| | - Ana P Beck da Silva Etges
- Department of Industrial Engineering, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil; National Institute for Health Technology Assessment - IATS/CNPq, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Giácomo Balbinotto Neto
- Graduate Program of Economy, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil; National Institute for Health Technology Assessment - IATS/CNPq, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Carisi Anne Polanczyk
- National Institute for Health Technology Assessment - IATS/CNPq, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
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Tseng P, Kaplan RS, Richman BD, Shah MA, Schulman KA. Administrative Costs Associated With Physician Billing and Insurance-Related Activities at an Academic Health Care System. JAMA 2018; 319:691-697. [PMID: 29466590 PMCID: PMC5839285 DOI: 10.1001/jama.2017.19148] [Citation(s) in RCA: 74] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Accepted: 01/17/2018] [Indexed: 11/14/2022]
Abstract
Importance Administrative costs in the US health care system are an important component of total health care spending, and a substantial proportion of these costs are attributable to billing and insurance-related activities. Objective To examine and estimate the administrative costs associated with physician billing activities in a large academic health care system with a certified electronic health record system. Design, Setting, and Participants This study used time-driven activity-based costing. Interviews were conducted with 27 health system administrators and 34 physicians in 2016 and 2017 to construct a process map charting the path of an insurance claim through the revenue cycle management process. These data were used to calculate the cost for each major billing and insurance-related activity and were aggregated to estimate the health system's total cost of processing an insurance claim. Exposures Estimated time required to perform billing and insurance-related activities, based on interviews with management personnel and physicians. Main Outcomes and Measures Estimated billing and insurance-related costs for 5 types of patient encounters: primary care visits, discharged emergency department visits, general medicine inpatient stays, ambulatory surgical procedures, and inpatient surgical procedures. Results Estimated processing time and total costs for billing and insurance-related activities were 13 minutes and $20.49 for a primary care visit, 32 minutes and $61.54 for a discharged emergency department visit, 73 minutes and $124.26 for a general inpatient stay, 75 minutes and $170.40 for an ambulatory surgical procedure, and 100 minutes and $215.10 for an inpatient surgical procedure. Of these totals, time and costs for activities carried out by physicians were estimated at a median of 3 minutes or $6.36 for a primary care visit, 3 minutes or $10.97 for an emergency department visit, 5 minutes or $13.29 for a general inpatient stay, 15 minutes or $51.20 for an ambulatory surgical procedure, and 15 minutes or $51.20 for an inpatient surgical procedure. Of professional revenue, professional billing costs were estimated to represent 14.5% for primary care visits, 25.2% for emergency department visits, 8.0% for general medicine inpatient stays, 13.4% for ambulatory surgical procedures, and 3.1% for inpatient surgical procedures. Conclusions and Relevance In a time-driven activity-based costing study in a large academic health care system with a certified electronic health record system, the estimated costs of billing and insurance-related activities ranged from $20 for a primary care visit to $215 for an inpatient surgical procedure. Knowledge of how specific billing and insurance-related activities contribute to administrative costs may help inform policy solutions to reduce these expenses.
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Affiliation(s)
- Phillip Tseng
- Duke University School of Medicine, Durham, North Carolina
| | | | | | | | - Kevin A. Schulman
- Harvard Business School, Boston, Massachusetts
- Duke Clinical Research Institute and Department of Medicine, Durham, North Carolina
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Frank SJ, Pugh TJ, Blanchard P, Mahmood U, Graber WJ, Kudchadker RJ, Davis JW, Kim J, Choi H, Troncoso P, Kuban DA, Choi S, McGuire S, Hoffman KE, Chen HC, Wang X, Swanson DA. Prospective Phase 2 Trial of Permanent Seed Implantation Prostate Brachytherapy for Intermediate-Risk Localized Prostate Cancer: Efficacy, Toxicity, and Quality of Life Outcomes. Int J Radiat Oncol Biol Phys 2018; 100:374-382. [DOI: 10.1016/j.ijrobp.2017.09.050] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 09/05/2017] [Accepted: 09/29/2017] [Indexed: 01/23/2023]
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25
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Blanchard P, Pugh TJ, Swanson DA, Mahmood U, Chen HC, Wang X, Graber WJ, Kudchadker RJ, Bruno T, Feeley T, Frank SJ. Patient-reported health-related quality of life for men treated with low-dose-rate prostate brachytherapy as monotherapy with 125-iodine, 103-palladium, or 131-cesium: Results of a prospective phase II study. Brachytherapy 2017; 17:265-276. [PMID: 29269207 DOI: 10.1016/j.brachy.2017.11.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 11/04/2017] [Accepted: 11/09/2017] [Indexed: 11/26/2022]
Abstract
PURPOSE To compare quality of life (QoL) after brachytherapy with one of the three approved radioactive isotopes. METHODS AND MATERIALS Patients with mostly favorable intermediate-risk prostate cancer were treated on this prospective phase II trial with brachytherapy as monotherapy, without hormonal therapy. QoL was recorded at baseline and each follow-up by using the Expanded Prostate Cancer Index Composite instrument. The minimal clinically important difference was defined as half the standard deviation of the baseline score for each domain. Mixed effect models were used to compare the different isotopes, and time-driven activity-based costing was used to compute costs. RESULTS From 2006 to 2013, 300 patients were treated with iodine-125 (I-125, n = 98, prescribed dose [PD] = 145 Gy), palladium-103 (Pd-103, n = 102, PD = 125 Gy), or cesium-131 (Cs-131, n = 100, PD = 115 Gy). Median age was 64.9 years. Median follow-up time was 5.1 years for the entire cohort, and 7.1, 4.8 and 3.3 years for I-125, Pd-103, and Cs-131 groups, respectively. All three isotope groups showed an initial drop in QoL at first follow-up, which gradually improved over the first 2 years for urinary and bowel domains. QoL profiles were similar between I-125 and Pd-103, whereas Cs-131 showed a statistically significant decrease in QoL regarding bowel and sexual function at 12 months compared with Pd-103. However, these differences did not reach the minimal clinically important difference. Compared with I-125, the use of Pd-103 or Cs-131 resulted in cost increases of 18% and 34% respectively. CONCLUSIONS The three different isotopes produced a similar QoL profile. Statistically significant differences favored Pd-103/I-125 over Cs-131 for bowel and sexual QoL, but this did not reach clinical significance.
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Affiliation(s)
- Pierre Blanchard
- Department of Radiation Oncology, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX; Department of Radiation Oncology, Gustave Roussy Cancer Center, Villejuif, France
| | - Thomas J Pugh
- Department of Radiation Oncology, University of Colorado School of Medicine, Houston, TX
| | - David A Swanson
- Department of Urology, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Usama Mahmood
- Department of Radiation Oncology, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Hsiang-Chun Chen
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Xuemei Wang
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - William J Graber
- Department of Urology, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Rajat J Kudchadker
- Department of Radiation Physics, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Teresa Bruno
- Department of Radiation Oncology, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Steven J Frank
- Department of Radiation Oncology, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX.
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Blanchard P, Davis JW, Frank SJ, Kim J, Pettaway CA, Pugh TJ, Pisters LL, Ward JF, Choi S, Chapin BF, Hoffman K, Navai N, Achim M, McGuire SE, Matin SF, Nguyen Q, Mahmood U, Graber WJ, Chen HC, Wang X, Kuban DA. Quality of life after brachytherapy or bilateral nerve-sparing robot-assisted radical prostatectomy for prostate cancer: a prospective cohort. BJU Int 2017; 121:540-548. [DOI: 10.1111/bju.14021] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Pierre Blanchard
- Department of Radiation Oncology; Division of Radiation Oncology; University of Texas MD Anderson Cancer Center; Houston TX USA
| | - John W. Davis
- Department of Urology; Division of Surgery; University of Texas MD Anderson Cancer Center; Houston TX USA
| | - Steven J. Frank
- Department of Radiation Oncology; Division of Radiation Oncology; University of Texas MD Anderson Cancer Center; Houston TX USA
| | - Jeri Kim
- Department of Genitourinary Medical Oncology; Division of Cancer Medicine; University of Texas MD Anderson Cancer Center; Houston TX USA
| | - Curtis A. Pettaway
- Department of Urology; Division of Surgery; University of Texas MD Anderson Cancer Center; Houston TX USA
| | - Thomas J. Pugh
- Department of Radiation Oncology; Division of Radiation Oncology; University of Texas MD Anderson Cancer Center; Houston TX USA
- Department of Radiation Oncology; University of Colorado School of Medicine; Aurora CO USA
| | - Louis L. Pisters
- Department of Urology; Division of Surgery; University of Texas MD Anderson Cancer Center; Houston TX USA
| | - John F. Ward
- Department of Urology; Division of Surgery; University of Texas MD Anderson Cancer Center; Houston TX USA
| | - Seungtaek Choi
- Department of Radiation Oncology; Division of Radiation Oncology; University of Texas MD Anderson Cancer Center; Houston TX USA
| | - Brian F. Chapin
- Department of Urology; Division of Surgery; University of Texas MD Anderson Cancer Center; Houston TX USA
| | - Karen Hoffman
- Department of Radiation Oncology; Division of Radiation Oncology; University of Texas MD Anderson Cancer Center; Houston TX USA
| | - Neema Navai
- Department of Urology; Division of Surgery; University of Texas MD Anderson Cancer Center; Houston TX USA
| | - Mary Achim
- Department of Urology; Division of Surgery; University of Texas MD Anderson Cancer Center; Houston TX USA
| | - Sean E. McGuire
- Department of Radiation Oncology; Division of Radiation Oncology; University of Texas MD Anderson Cancer Center; Houston TX USA
| | - Surena F. Matin
- Department of Urology; Division of Surgery; University of Texas MD Anderson Cancer Center; Houston TX USA
| | - Quynh Nguyen
- Department of Radiation Oncology; Division of Radiation Oncology; University of Texas MD Anderson Cancer Center; Houston TX USA
| | - Usama Mahmood
- Department of Radiation Oncology; Division of Radiation Oncology; University of Texas MD Anderson Cancer Center; Houston TX USA
- Department of Radiation Oncology; Long Beach Memorial Medical Center; Long Beach CA USA
| | - William J. Graber
- Department of Urology; Division of Surgery; University of Texas MD Anderson Cancer Center; Houston TX USA
| | - Hsiang-Chun Chen
- Department of Biostatistics; University of Texas MD Anderson Cancer Center; Houston TX USA
| | - Xuemei Wang
- Department of Biostatistics; University of Texas MD Anderson Cancer Center; Houston TX USA
| | - Deborah A. Kuban
- Department of Radiation Oncology; Division of Radiation Oncology; University of Texas MD Anderson Cancer Center; Houston TX USA
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Isaacson D, Ahmad T, Metzler I, Tzou DT, Taguchi K, Usawachintachit M, Zetumer S, Sherer B, Stoller M, Chi T. Defining the Costs of Reusable Flexible Ureteroscope Reprocessing Using Time-Driven Activity-Based Costing. J Endourol 2017; 31:1026-1031. [PMID: 28830223 PMCID: PMC5652038 DOI: 10.1089/end.2017.0463] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE Careful decontamination and sterilization of reusable flexible ureteroscopes used in ureterorenoscopy cases prevent the spread of infectious pathogens to patients and technicians. However, inefficient reprocessing and unavailability of ureteroscopes sent out for repair can contribute to expensive operating room (OR) delays. Time-driven activity-based costing (TDABC) was applied to describe the time and costs involved in reprocessing. MATERIALS AND METHODS Direct observation and timing were performed for all steps in reprocessing of reusable flexible ureteroscopes following operative procedures. Estimated times needed for each step by which damaged ureteroscopes identified during reprocessing are sent for repair were characterized through interviews with purchasing analyst staff. Process maps were created for reprocessing and repair detailing individual step times and their variances. Cost data for labor and disposables used were applied to calculate per minute and average step costs. RESULTS Ten ureteroscopes were followed through reprocessing. Process mapping for ureteroscope reprocessing averaged 229.0 ± 74.4 minutes, whereas sending a ureteroscope for repair required an estimated 143 minutes per repair. Most steps demonstrated low variance between timed observations. Ureteroscope drying was the longest and highest variance step at 126.5 ± 55.7 minutes and was highly dependent on manual air flushing through the ureteroscope working channel and ureteroscope positioning in the drying cabinet. Total costs for reprocessing totaled $96.13 per episode, including the cost of labor and disposable items. CONCLUSIONS Utilizing TDABC delineates the full spectrum of costs associated with ureteroscope reprocessing and identifies areas for process improvement to drive value-based care. At our institution, ureteroscope drying was one clearly identified target area. Implementing training in ureteroscope drying technique could save up to 2 hours per reprocessing event, potentially preventing expensive OR delays.
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Affiliation(s)
- Dylan Isaacson
- School of Medicine, University of California, San Francisco, San Francisco, California
| | - Tessnim Ahmad
- School of Medicine, University of California, San Francisco, San Francisco, California
| | - Ian Metzler
- Department of Urology, University of California, San Francisco, San Francisco, California
| | - David T. Tzou
- Department of Urology, University of California, San Francisco, San Francisco, California
| | - Kazumi Taguchi
- Department of Urology, University of California, San Francisco, San Francisco, California
- Department of Nephro-Urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Manint Usawachintachit
- Department of Surgery, Division of Urology, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, Thailand
| | - Samuel Zetumer
- School of Medicine, University of California, San Francisco, San Francisco, California
| | - Benjamin Sherer
- Department of Urology, University of California, San Francisco, San Francisco, California
| | - Marshall Stoller
- Department of Urology, University of California, San Francisco, San Francisco, California
| | - Thomas Chi
- Department of Urology, University of California, San Francisco, San Francisco, California
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Bauer-Nilsen K, Hill C, Trifiletti DM, Libby B, Lash DH, Lain M, Christodoulou D, Hodge C, Showalter TN. Evaluation of Delivery Costs for External Beam Radiation Therapy and Brachytherapy for Locally Advanced Cervical Cancer Using Time-Driven Activity-Based Costing. Int J Radiat Oncol Biol Phys 2017; 100:88-94. [PMID: 29079120 DOI: 10.1016/j.ijrobp.2017.09.004] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 09/02/2017] [Accepted: 09/06/2017] [Indexed: 11/28/2022]
Abstract
PURPOSE To evaluate the delivery costs, using time-driven activity-based costing, and reimbursement for definitive radiation therapy for locally advanced cervical cancer. METHODS AND MATERIALS Process maps were created to represent each step of the radiation treatment process and included personnel, equipment, and consumable supplies used to deliver care. Personnel were interviewed to estimate time involved to deliver care. Salary data, equipment purchasing information, and facilities costs were also obtained. We defined the capacity cost rate (CCR) for each resource and then calculated the total cost of patient care according to CCR and time for each resource. Costs were compared with 2016 Medicare reimbursement and relative value units (RVUs). RESULTS The total cost of radiation therapy for cervical cancer was $12,861.68, with personnel costs constituting 49.8%. Brachytherapy cost $8610.68 (66.9% of total) and consumed 423 minutes of attending radiation oncologist time (80.0% of total). External beam radiation therapy cost $4055.01 (31.5% of total). Personnel costs were higher for brachytherapy than for the sum of simulation and external beam radiation therapy delivery ($4798.73 vs $1404.72). A full radiation therapy course provides radiation oncologists 149.77 RVUs with intensity modulated radiation therapy or 135.90 RVUs with 3-dimensional conformal radiation therapy, with total reimbursement of $23,321.71 and $16,071.90, respectively. Attending time per RVU is approximately 4-fold higher for brachytherapy (5.68 minutes) than 3-dimensional conformal radiation therapy (1.63 minutes) or intensity modulated radiation therapy (1.32 minutes). CONCLUSIONS Time-driven activity-based costing was used to calculate the total cost of definitive radiation therapy for cervical cancer, revealing that brachytherapy delivery and personnel resources constituted the majority of costs. However, current reimbursement policy does not reflect the increased attending physician effort and delivery costs of brachytherapy. We hypothesize that the significant discrepancy between treatment costs and physician effort versus reimbursement may be a potential driver of reported national trends toward poor compliance with brachytherapy, and we suggest re-evaluation of payment policies to incentivize quality care.
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Affiliation(s)
- Kristine Bauer-Nilsen
- Department of Radiation Oncology, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Colin Hill
- Department of Radiation Oncology, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Daniel M Trifiletti
- Department of Radiation Oncology, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Bruce Libby
- Department of Radiation Oncology, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Donna H Lash
- Department of Radiation Oncology, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Melody Lain
- Department of Radiation Oncology, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Deborah Christodoulou
- Department of Radiation Oncology, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Constance Hodge
- Department of Radiation Oncology, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Timothy N Showalter
- Department of Radiation Oncology, University of Virginia School of Medicine, Charlottesville, Virginia.
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29
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Frank SJ, Mourtada F. Bending the slope of the brachytherapy curve: Magnetic resonance imaging-assisted radiosurgery for the treatment of prostate cancer. Brachytherapy 2017; 16:657-658. [DOI: 10.1016/j.brachy.2017.05.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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30
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Bradley SM, Strauss CE, Ho PM. Value in cardiovascular care. Heart 2017; 103:1238-1243. [DOI: 10.1136/heartjnl-2016-309753] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 03/31/2017] [Accepted: 04/03/2017] [Indexed: 11/04/2022] Open
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31
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Thaker NG, Orio PF, Potters L. Defining the value of magnetic resonance imaging in prostate brachytherapy using time-driven activity-based costing. Brachytherapy 2017; 16:665-671. [PMID: 28187994 DOI: 10.1016/j.brachy.2016.11.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Revised: 11/29/2016] [Accepted: 11/29/2016] [Indexed: 10/20/2022]
Abstract
Magnetic resonance imaging (MRI) simulation and planning for prostate brachytherapy (PBT) may deliver potential clinical benefits but at an unknown cost to the provider and healthcare system. Time-driven activity-based costing (TDABC) is an innovative bottom-up costing tool in healthcare that can be used to measure the actual consumption of resources required over the full cycle of care. TDABC analysis was conducted to compare patient-level costs for an MRI-based versus traditional PBT workflow. TDABC cost was only 1% higher for the MRI-based workflow, and utilization of MRI allowed for cost shifting from other imaging modalities, such as CT and ultrasound, to MRI during the PBT process. Future initiatives will be required to follow the costs of care over longer periods of time to determine if improvements in outcomes and toxicities with an MRI-based approach lead to lower resource utilization and spending over the long-term. Understanding provider costs will become important as healthcare reform transitions to value-based purchasing and other alternative payment models.
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Affiliation(s)
- Nikhil G Thaker
- Department of Radiation Oncology, Arizona Oncology, The US Oncology Network, Tucson, AZ.
| | - Peter F Orio
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Milford Regional Medical Center, Boston, MA
| | - Louis Potters
- Department of Radiation Medicine at North Shore-LIJ Health System, New Hyde Park, NY
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32
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Mandelblatt JS, Ramsey SD, Lieu TA, Phelps CE. Evaluating Frameworks That Provide Value Measures for Health Care Interventions. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2017; 20:185-192. [PMID: 28237193 PMCID: PMC5539503 DOI: 10.1016/j.jval.2016.11.013] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 11/09/2016] [Accepted: 11/10/2016] [Indexed: 05/09/2023]
Abstract
The recent acceleration of scientific discovery has led to greater choices in health care. New technologies, diagnostic tests, and pharmaceuticals have widely varying impact on patients and populations in terms of benefits, toxicities, and costs, stimulating a resurgence of interest in the creation of frameworks intended to measure value in health. Many of these are offered by providers and/or advocacy organizations with expertise and interest in specific diseases (e.g., cancer and heart disease). To help assess the utility of and the potential biases embedded in these frameworks, we created an evaluation taxonomy with seven basic components: 1) define the purpose; 2) detail the conceptual approach, including perspectives, methods for obtaining preferences of decision makers (e.g., patients), and ability to incorporate multiple dimensions of value; 3) discuss inclusions and exclusions of elements included in the framework, and whether the framework assumes clinical intervention or offers alternatives such as palliative care or watchful waiting; 4) evaluate data sources and their scientific validity; 5) assess the intervention's effect on total costs of treating a defined population; 6) analyze how uncertainty is incorporated; and 7) illuminate possible conflicts of interest among those creating the framework. We apply the taxonomy to four representative value frameworks recently published by professional organizations focused on treatment of cancer and heart disease and on vaccine use. We conclude that each of these efforts has strengths and weaknesses when evaluated using our taxonomy, and suggest pathways to enhance the utility of value-assessing frameworks for policy and clinical decision making.
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Affiliation(s)
- Jeanne S Mandelblatt
- Department of Oncology, Georgetown University Medical Center, Washington, DC, USA; Lombardi Comprehensive Cancer Center, Washington, DC, USA
| | - Scott D Ramsey
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Tracy A Lieu
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
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Clinical use of magnetic resonance imaging across the prostate brachytherapy workflow. Brachytherapy 2017; 16:734-742. [PMID: 28153700 DOI: 10.1016/j.brachy.2016.11.012] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 11/08/2016] [Accepted: 11/29/2016] [Indexed: 11/21/2022]
Abstract
MRI produces better soft tissue contrast than does ultrasonography or computed tomography for visualizing male pelvic anatomy and prostate cancer. Better visualization of the tumor and organs at risk could allow better conformation of the dose to the target volumes while at the same time minimizing the dose to critical structures and the associated toxicity. Although the use of MRI for prostate brachytherapy would theoretically result in an improved therapeutic ratio, its implementation been slow, mostly because of technical challenges. In this review, we describe the potential role of MRI at different steps in the treatment workflow for prostate brachytherapy: for patient selection, treatment planning, in the operating room, or for postimplant assessment. We further present the current clinical experience with MRI-guided prostate brachytherapy, both for permanent seed implantation and high-dose-rate brachytherapy.
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34
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Blanchard P, Volk RJ, Ringash J, Peterson SK, Hutcheson KA, Frank SJ. Assessing head and neck cancer patient preferences and expectations: A systematic review. Oral Oncol 2016; 62:44-53. [DOI: 10.1016/j.oraloncology.2016.09.008] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Revised: 09/20/2016] [Accepted: 09/23/2016] [Indexed: 10/20/2022]
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