title: Defining the value framework for prostate brachytherapy using patient-centered outcome metrics and time-driven activity-based costing.
abstract: Value, defined as outcomes over costs, has been proposed as a measure to evaluate prostate cancer (PCa) treatments. We analyzed standardized outcomes and time-driven activity-based costing (TDABC) for prostate brachytherapy (PBT) to define a value framework.
  
  
  
  Patients with low-risk PCa treated with low-dose-rate PBT between 1998 and 2009 were included. Outcomes were recorded according to the International Consortium for Health Outcomes Measurement standard set, which includes acute toxicity, patient-reported outcomes, and recurrence and survival outcomes. Patient-level costs to 1 year after PBT were collected using TDABC. Process mapping and radar chart analyses were conducted to visualize this value framework.
  
  
  
  A total of 238 men were eligible for analysis. Median age was 64 (range, 46-81). Median followup was 5 years (0.5-12.1). There were no acute Grade 3-5 complications. Expanded Prostate Cancer Index Composite 50 scores were favorable, with no clinically significant changes from baseline to last followup at 48 months for urinary incontinence/bother, bowel bother, sexual function, and vitality. Ten-year outcomes were favorable, including biochemical failure-free survival of 84.1%, metastasis-free survival 99.6%, PCa-specific survival 100%, and overall survival 88.6%. TDABC analysis demonstrated low resource utilization for PBT, with 41% and 10% of costs occurring in the operating room and with the MRI scan, respectively. The radar chart allowed direct visualization of outcomes and costs.
  
  
  
  We successfully created a visual framework to define the value of PBT using the International Consortium for Health Outcomes Measurement standard set and TDABC costs. PBT is associated with excellent outcomes and low costs. Widespread adoption of this methodology will enable value comparisons across providers, institutions, and treatment modalities.
authors.affiliation: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX; The Institute for Cancer Care Innovation, The University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Nikhil G
authors.initials: NG
authors.lastname: Thaker
authors.affiliation: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Pugh
authors.affiliation: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Usama
authors.initials: U
authors.lastname: Mahmood
authors.affiliation: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Seungtaek
authors.initials: S
authors.lastname: Choi
authors.affiliation: Office of the SVP/Hospitals & Clinics, The University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Tracy E
authors.initials: TE
authors.lastname: Spinks
authors.affiliation: Department of Radiation Oncology, Dana-Farber Cancer Institute, Boston, MA.
authors.forename: Neil E
authors.initials: NE
authors.lastname: Martin
authors.affiliation: Department of Radiation Oncology, Mayo Clinic, Scottsdale, AZ.
authors.forename: Terence T
authors.initials: TT
authors.lastname: Sio
authors.affiliation: Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Rajat J
authors.initials: RJ
authors.lastname: Kudchadker
authors.affiliation: Harvard Business School, Boston, MA.
authors.forename: Robert S
authors.initials: RS
authors.lastname: Kaplan
authors.affiliation: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Deborah A
authors.initials: DA
authors.lastname: Kuban
authors.affiliation: Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: David A
authors.initials: DA
authors.lastname: Swanson
authors.affiliation: Department of Radiation Oncology, Dana-Farber/Brigham and Women's Cancer Centers, Boston, MA.
authors.forename: Peter F
authors.initials: PF
authors.lastname: Orio
authors.affiliation: Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Zelefsky
authors.affiliation: Department of Radiation Oncology, North Shore-LIJ Health System, New York, NY.
authors.forename: Brett W
authors.initials: BW
authors.lastname: Cox
authors.affiliation: Department of Radiation Oncology, North Shore-LIJ Health System, New York, NY.
authors.forename: Louis
authors.initials: L
authors.lastname: Potters
authors.affiliation: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Buchholz
authors.affiliation: The Institute for Cancer Care Innovation, The University of Texas MD Anderson Cancer Center, Houston, TX; Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Thomas W
authors.initials: TW
authors.lastname: Feeley
authors.affiliation: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX. Electronic address: sjfrank@mdanderson.org.
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Frank
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000009:adverse effects / Q000191:economics; D003362:Cost-Benefit Analysis / Q000379:methods*; D003626:Data Display; D018572:Disease-Free Survival; D005500:Follow-Up Studies; D017048:Health Care Costs; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000191:economics; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000209:etiology; D000071066:Patient Reported Outcome Measures; D018802:Patient-Centered Care; D017430:Prostate-Specific Antigen; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging / Q000532:radiotherapy*; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D017430:Prostate-Specific Antigen
keywords: Brachytherapy; Outcomes; Prostate; TDABC; Time-driven activity-based costing; Value