Time-Driven, Activity-Based Cost Analysis of Radiation Treatment Options for Spinal Metastases
Time-Driven, Activity-Based Cost Analysis of Radiation Treatment Options for Spinal Metastases
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DOI：
10.1200/jop.19.00480
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发表时间：
2020-03-01
影响因子：
4
通讯作者：
Ghia, Amol J.
中科院分区：
文献类型：
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作者：
Boyce-Fappiano, David;Ning, Matthew S.;Ghia, Amol J.
脊柱转移瘤有多种治疗选择，包括多种放射治疗（RT）技术：三维（3D）常规RT（3D-RT）、调强RT（IMRT）和脊柱立体定向放射外科（SSRS）。虽然存在关于不同方案之间报销差异的数据，但提供者提供护理的成本差异尚未得到评估。我们量化的机构成本与RT脊柱转移瘤，使用时间驱动的活动为基础的costingmodel.METHODS之间进行比较（1）10-fraction 3D-RT 30戈伊，（2）10-fraction IMRT 30戈伊，（3）3-fraction SSRS（SSRS-3）27戈伊，和（4）单次分割SSRS（SSRS-1）18戈伊。从咨询到治疗后30天的随访，制定了过程图。通过小组访谈确定了处理时间，并从机构薪金数据中提取了人员费用。确定每个资源的能力成本率，然后乘以活动时间来计算成本，将其相加以确定总cost.Results SSRS-1的全周期成本分别比IMRT和3D-RT低17%和高17%。SSRS-3的全周期成本仅比10次IMRT高1%。IMRT的技术成本分别比SSRS-3和SSRS-1高50%和77%。相比之下，SSRS-1的人员成本分别比IMRT和3D-RT高3%和28%（P < .001）。通过量化提供者护理提供成本，这项分析支持SSRS-1的机构资源效率。利用这些资源和成本数据来评估临床结果将为最高价值的模式提供更多的见解，并可能为替代支付模式、运营工作流程和机构资源分配提供信息。(c)2019年美国临床肿瘤学会
PURPOSE Several treatment options for spinal metastases exist, including multiple radiation therapy (RT) techniques: three-dimensional (3D) conventional RT (3D-RT), intensity-modulated RT (IMRT), and spine stereotactic radiosurgery (SSRS). Although data exist regarding reimbursement differences across regimens, differences in provider care delivery costs have yet to be evaluated. We quantified institutional costs associated with RT for spinal metastases, using a time-driven activity-based costing model.METHODS Comparisons were made between (1) 10-fraction 3D-RT to 30 Gy, (2) 10-fraction IMRT to 30 Gy, (3) 3-fraction SSRS (SSRS-3) to 27 Gy, and (4) single-fraction SSRS (SSRS-1) to 18 Gy. Process maps were developed from consultation through follow-up 30 days post-treatment. Process times were determined through panel interviews, and personnel costs were extracted from institutional salary data. The capacity cost rate was determined for each resource, then multiplied by activity time to calculate costs, which were summed to determine total cost.RESULTS Full-cycle costs of SSRS-1 were 17% lower and 17% higher compared with IMRT and 3D-RT, respectively. Full-cycle costs for SSRS-3 were only 1% greater than 10-fraction IMRT. Technical costs for IMRT were 50% and 77% more than SSRS-3 and SSRS-1. In contrast, personnel costs were 3% and 28% higher for SSRS-1 than IMRT and 3D-RT, respectively (P < .001).CONCLUSIONS Resource utilization varies significantly among treatment options. By quantifying provider care delivery costs, this analysis supports the institutional resource efficiency of SSRS-1. Incorporating clinical outcomes with such resource and cost data will provide additional insight into the highest value modalities and may inform alternative payment models, operational workflows, and institutional resource allocation. (c) 2019 by American Society of Clinical Oncology