title: Measuring the cost of care in benign prostatic hyperplasia using time-driven activity-based costing (TDABC).
abstract: BACKGROUND
  Determining '"value'" in health care, defined as outcomes per unit cost, depends on accurately measuring cost. We used time-driven activity-based costing (TDABC) to determine the cost of care in men with benign prostatic hyperplasia (BPH) - a common urologic condition.
  
  
  METHODS
  We implemented TDABC across the entire care pathway for BPH including primary and specialist care in both inpatient and outpatient settings. A team of expert stakeholders created detailed process maps, determined space and product costs, and calculated personnel capacity cost rates. A model pathway was derived from practice guidelines and calculated costs were applied.
  
  
  RESULTS
  Although listed as 'optional' in practice guidelines, invasive diagnostic testing can increase costs by 150% compared with the standalone urology clinic visit. Of five different surgical options, a 400% cost discrepancy exists between the most and least expensive treatments.
  
  
  CONCLUSIONS
  TDABC can be used to measure cost across an entire care pathway in a large academic medical center. Sizable cost variation exists between diagnostic and surgical modalities for men with BPH.
  
  
  CONCLUSIONS
  As financial risk is shifted toward providers, understanding the cost of care will be vital. Future work is needed to determine outcome discrepancy between the diagnostic and surgical modalities in BPH.
authors.affiliation: Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Jonsson Comprehensive Cancer Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA. Electronic address: alkaplan@mednet.ucla.edu.
authors.forename: A L
authors.initials: AL
authors.lastname: Kaplan
authors.affiliation: Performance Excellence, UCLA Health System, USA.
authors.forename: N
authors.initials: N
authors.lastname: Agarwal
authors.affiliation: Performance Excellence, UCLA Health System, USA.
authors.forename: N P
authors.initials: NP
authors.lastname: Setlur
authors.affiliation: Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Institute of Urologic Oncology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
authors.forename: H J
authors.initials: HJ
authors.lastname: Tan
authors.affiliation: Operative Services, UCLA Health System, USA.
authors.forename: D
authors.initials: D
authors.lastname: Niedzwiecki
authors.affiliation: Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
authors.forename: N
authors.initials: N
authors.lastname: McLaughlin
authors.affiliation: Performance Excellence, UCLA Health System, USA.
authors.forename: M A
authors.initials: MA
authors.lastname: Burke
authors.affiliation: Institute for Innovations in Health, UCLA Health System, USA.
authors.forename: K
authors.initials: K
authors.lastname: Steinberg
authors.affiliation: Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Jonsson Comprehensive Cancer Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Institute of Urologic Oncology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
authors.forename: K
authors.initials: K
authors.lastname: Chamie
authors.affiliation: Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Jonsson Comprehensive Cancer Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Institute of Urologic Oncology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
authors.forename: C S
authors.initials: CS
authors.lastname: Saigal
mesh_terms: D000046:Academic Medical Centers; D000553:Ambulatory Care; D003363:Cost Control; D003362:Cost-Benefit Analysis; D003365:Costs and Cost Analysis; D003695:Delivery of Health Care; D017048:Health Care Costs; D006801:Humans; D008297:Male; D011470:Prostatic Hyperplasia / Q000191:economics / Q000628:therapy*; D013997:Time Factors
keywords: Benign prostatic hyperplasia; Cost; Time-driven activity-based costing; Value; Value-based care