Large cost variation over 12 years of follow-up due to equipment, visits
THURSDAY, Nov. 5, 2015 (HealthDay News) — There is significant cost variation between competing treatments for low-risk prostate cancer, according to a study published online Nov. 2 in Cancer.
Aaron A. Laviana, M.D., from the University of California, Los Angeles, and colleagues developed process maps 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 costs of materials, equipment, personnel, and space were calculated per unit of time, with time-driven activity-based costing (TDABC) defined as the sum of its resources for each treatment.
The researchers observed substantial cost variation at five years, with costs ranging from $7,298 for AS to $23,565 for IMRT. This variation remained consistent through 12 years of follow-up. Cost savings between LDR brachytherapy and HDR brachytherapy were attributable to shorter procedure times and fewer visits required ($8,978 and $11,448, respectively), as were the cost savings between SBRT ($11,665) and IMRT. The high cost of RALP ($16,946) was attributable to equipment costs and an inpatient stay. Single-use equipment for cryotherapy increased cost compared to LDR brachytherapy. After seven years of follow-up, AS reached cost equivalence with LDR brachytherapy.
“The use of TDABC is feasible for analyzing cancer services and provides insights into cost-reduction tactics in an era focused on emphasizing value,” the authors write.
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