title: Time-driven activity-based costing of low-dose-rate and high-dose-rate brachytherapy for low-risk prostate cancer.
abstract: Cost estimates through traditional hospital accounting systems are often arbitrary and ambiguous. We used time-driven activity-based costing (TDABC) to determine the true cost of low-dose-rate (LDR) and high-dose-rate (HDR) brachytherapy for prostate cancer and demonstrate opportunities for cost containment at an academic referral center.
  
  
  
  We implemented TDABC for patients treated with I-125, preplanned LDR and computed tomography based HDR brachytherapy with two implants from initial consultation through 12-month followup. We constructed detailed process maps for provision of both HDR and LDR. Personnel, space, equipment, and material costs of each step were identified and used to derive capacity cost rates, defined as price per minute. Each capacity cost rate was then multiplied by the relevant process time and products were summed to determine total cost of care.
  
  
  
  The calculated cost to deliver HDR was greater than LDR by $2,668.86 ($9,538 vs. $6,869). The first and second HDR treatment day cost $3,999.67 and $3,955.67, whereas LDR was delivered on one treatment day and cost $3,887.55. The greatest overall cost driver for both LDR and HDR was personnel at 65.6% ($4,506.82) and 67.0% ($6,387.27) of the total cost. After personnel costs, disposable materials contributed the second most for LDR ($1,920.66, 28.0%) and for HDR ($2,295.94, 24.0%).
  
  
  
  With TDABC, the true costs to deliver LDR and HDR from the health system perspective were derived. Analysis by physicians and hospital administrators regarding the cost of care afforded redesign opportunities including delivering HDR as one implant. Our work underscores the need to assess clinical outcomes to understand the true difference in value between these modalities.
authors.affiliation: Department of Urology, Institute of Urologic Oncology, David Geffen School of Medicine at University of California, Los Angeles, CA. Electronic address: amilg@bidmc.harvard.edu.
authors.forename: Annette M
authors.initials: AM
authors.lastname: Ilg
authors.affiliation: Department of Urology, Institute of Urologic Oncology, David Geffen School of Medicine at University of California, Los Angeles, CA.
authors.forename: Aaron A
authors.initials: AA
authors.lastname: Laviana
authors.affiliation: Department of Radiation Oncolgoy, David Geffen School of Medicine at University of California, Los Angeles, CA.
authors.forename: Mitchell
authors.initials: M
authors.lastname: Kamrava
authors.affiliation: Department of Radiation Oncolgoy, David Geffen School of Medicine at University of California, Los Angeles, CA.
authors.forename: Darlene
authors.initials: D
authors.lastname: Veruttipong
authors.affiliation: Department of Radiation Oncolgoy, David Geffen School of Medicine at University of California, Los Angeles, CA.
authors.forename: Michael
authors.initials: M
authors.lastname: Steinberg
authors.affiliation: Department of Radiation Oncolgoy, David Geffen School of Medicine at University of California, Los Angeles, CA.
authors.forename: Sang-June
authors.initials: SJ
authors.lastname: Park
authors.affiliation: Performance Excellence, Los Angeles Health System, University of California, Los Angeles, CA.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Burke
authors.affiliation: Operative Services, Los Angeles Health System, University of California, Los Angeles, CA.
authors.forename: Douglas
authors.initials: D
authors.lastname: Niedzwiecki
authors.affiliation: Department of Radiation Oncolgoy, David Geffen School of Medicine at University of California, Los Angeles, CA.
authors.forename: Patrick A
authors.initials: PA
authors.lastname: Kupelian
authors.affiliation: Department of Urology, Institute of Urologic Oncology, David Geffen School of Medicine at University of California, Los Angeles, CA.
authors.forename: Christopher
authors.initials: C
authors.lastname: Saigal
mesh_terms: D000046:Academic Medical Centers / Q000191:economics; D001918:Brachytherapy / Q000191:economics* / Q000379:methods; D002140:California; D003363:Cost Control / Q000379:methods; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011471:Prostatic Neoplasms / Q000191:economics* / Q000532:radiotherapy* / Q000601:surgery; D011879:Radiotherapy Dosage
keywords: Brachytherapy; Cost analysis; Prostate neoplasms; Time-driven activity-based costing; Value-based care