title: Cost of outpatient endoscopic sinus surgery from the perspective of the Canadian government: a time-driven activity-based costing approach.
abstract: BACKGROUND
  The time-driven activity-based costing (TD-ABC) method is a novel approach to quantify the costs of a complex system. The aim of this study was to apply the TD-ABC technique to define the overall cost of a routine outpatient endoscopic sinus surgery (ESS) from the perspective of the Canadian government payer.
  
  
  METHODS
  Costing perspective was the Canadian government payer. All monetary values are in Canadian dollars as of December 2012. Costs were obtained by contacting staff unions, reviewing purchasing databases and provincial physician fee schedules. Practical capacity time values were collected from the College and Association of Registered Nurses of Alberta. Capacity cost rates ($/min) were calculated for all staff, capital equipment, and hospital space.
  
  
  RESULTS
  The overall cost for routine outpatient ESS was $3510.31. The cost per ESS case for each clinical pathway encounter was as follows: preoperative holding ($49.19); intraoperative ($3296.60); sterilization ($90.20); postanesthesia care unit ($28.64); and postoperative day ward ($45.68). The 3 major cost drivers were physician fees, disposable equipment, and nursing costs. The intraoperative phase contributed to 94.5% of the overall cost.
  
  
  CONCLUSIONS
  This study applied the TD-ABC method to evaluate the cost of outpatient ESS from the perspective of the Canadian government payer and defined the overall cost to be $3510.31 per case.
authors.affiliation: Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Au
authors.forename: Luke
authors.initials: L
authors.lastname: Rudmik
mesh_terms: D000553:Ambulatory Care / Q000191:economics*; D002170:Canada; D003365:Costs and Cost Analysis; D004724:Endoscopy / Q000191:economics*; D005376:Financial Management; D005380:Financing, Government / Q000379:methods*; D006801:Humans; D007430:Intraoperative Care / Q000191:economics; D007902:Length of Stay / Q000191:economics; D010256:Paranasal Sinuses / Q000601:surgery*; D011300:Preoperative Care / Q000191:economics
keywords: accounting; activity-based costing; cost analysis; cost effectiveness; endoscopic sinus surgery