title: Utilizing time-driven activity-based costing to understand the short- and long-term costs of treating localized, low-risk prostate cancer.
abstract: BACKGROUND
  Given the costs of delivering care for men with prostate cancer remain poorly described, this article reports the results of time-driven activity-based costing (TDABC) for competing treatments of low-risk prostate cancer.
  
  
  METHODS
  Process maps were developed for each phase of care from the initial urologic visit through 12 years of follow-up for robotic-assisted laparoscopic prostatectomy (RALP), cryotherapy, high-dose rate (HDR) and low-dose rate (LDR) brachytherapy, intensity-modulated radiation therapy (IMRT), stereotactic body radiation therapy (SBRT), and active surveillance (AS). The last modality incorporated both traditional transrectal ultrasound (TRUS) biopsy and multiparametric-MRI/TRUS fusion biopsy. The costs of materials, equipment, personnel, and space were calculated per unit of time and based on the relative proportion of capacity used. TDABC for each treatment was defined as the sum of its resources.
  
  
  RESULTS
  Substantial cost variation was observed at 5 years, with costs ranging from $7,298 for AS to $23,565 for IMRT, and they remained consistent through 12 years of follow-up. LDR brachytherapy ($8,978) was notably cheaper than HDR brachytherapy ($11,448), and SBRT ($11,665) was notably cheaper than IMRT, with the cost savings attributable to shorter procedure times and fewer visits required for treatment. Both equipment costs and an inpatient stay ($2,306) contributed to the high cost of RALP ($16,946). Cryotherapy ($11,215) was more costly than LDR brachytherapy, largely because of increased single-use equipment costs ($6,292 vs $1,921). AS reached cost equivalence with LDR brachytherapy after 7 years of follow-up.
  
  
  CONCLUSIONS
  The use of TDABC is feasible for analyzing cancer services and provides insights into cost-reduction tactics in an era focused on emphasizing value. By detailing all steps from diagnosis and treatment through 12 years of follow-up for low-risk prostate cancer, this study has demonstrated significant cost variation between competing treatments.
authors.affiliation: Institute of Urologic Oncology, Department of Urology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California.
authors.forename: Aaron A
authors.initials: AA
authors.lastname: Laviana
authors.affiliation: Institute of Urologic Oncology, Department of Urology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California.
authors.forename: Annette M
authors.initials: AM
authors.lastname: Ilg
authors.affiliation: Department of Radiation Oncology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California.
authors.forename: Darlene
authors.initials: D
authors.lastname: Veruttipong
authors.affiliation: Institute of Urologic Oncology, Department of Urology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California.|Robert Wood Johnson Clinical Scholars Program, University of California Los Angeles, Los Angeles, California.
authors.forename: Hung-Jui
authors.initials: HJ
authors.lastname: Tan
authors.affiliation: Performance Excellence, University of California Los Angeles Health System, Los Angeles, California.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Burke
authors.affiliation: Operative Services, University of California Los Angeles Health System, Los Angeles, California.
authors.forename: Douglas R
authors.initials: DR
authors.lastname: Niedzwiecki
authors.affiliation: Department of Radiation Oncology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California.
authors.forename: Patrick A
authors.initials: PA
authors.lastname: Kupelian
authors.affiliation: Department of Radiation Oncology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California.
authors.forename: Chris R
authors.initials: CR
authors.lastname: King
authors.affiliation: Department of Radiation Oncology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California.
authors.forename: Michael L
authors.initials: ML
authors.lastname: Steinberg
authors.affiliation: Institute of Urologic Oncology, Department of Urology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California.
authors.forename: Chandan R
authors.initials: CR
authors.lastname: Kundavaram
authors.affiliation: Department of Radiation Oncology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California.
authors.forename: Mitchell
authors.initials: M
authors.lastname: Kamrava
authors.affiliation: Institute of Urologic Oncology, Department of Urology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California.
authors.forename: Alan L
authors.initials: AL
authors.lastname: Kaplan
authors.affiliation: Department of Radiology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California.
authors.forename: Andrew K
authors.initials: AK
authors.lastname: Moriarity
authors.affiliation: Department of Radiology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California.
authors.forename: William
authors.initials: W
authors.lastname: Hsu
authors.affiliation: Department of Radiology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California.
authors.forename: Daniel J A
authors.initials: DJ
authors.lastname: Margolis
authors.affiliation: Department of Urology, Weill Cornell Medical College/NewYork-Presbyterian Hospital, New York, New York.
authors.forename: Jim C
authors.initials: JC
authors.lastname: Hu
authors.affiliation: Institute of Urologic Oncology, Department of Urology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California.
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Saigal
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000191:economics*; D003362:Cost-Benefit Analysis; D005240:Feasibility Studies; D017048:Health Care Costs; D006801:Humans; D010535:Laparoscopy / Q000191:economics; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance; D011468:Prostatectomy / Q000191:economics* / Q000379:methods; D011471:Prostatic Neoplasms / Q000191:economics* / Q000473:pathology / Q000628:therapy*; D016634:Radiosurgery / Q000191:economics*; D050397:Radiotherapy, Intensity-Modulated / Q000191:economics*; D018570:Risk Assessment; D012307:Risk Factors; D065287:Robotic Surgical Procedures / Q000191:economics; D014481:United States; D057832:Watchful Waiting / Q000191:economics
keywords: active surveillance; brachytherapy; cost analysis; prostate neoplasms; radical prostatectomy; radiotherapy; value-based purchasing