Cost comparison of treating low- and intermediate-risk endometrial cancer using time-derived, activity-based costing (TDABC) in a large regional cancer network delivery model.

Abstract

9 Background: Value-based and quality health care delivery has become an important focus for many health care systems. The purpose of this study was to assess the cost differences in treating low and intermediate risk endometrial cancer using time-derived activity based costing (TDABC) in a large regional cancer network model. Methods: Process mapping and TDABC was performed in treating endometrial cancer patients at a large tertiary cancer center (main) with a regional cancer network program. Clinical visits and adjuvant therapy including high-dose rate vaginal cuff brachytherapy (VBT) and pelvic radiation (PRT) were performed in ambulatory treatment centers at each location. Surgery for endometrial cancer was performed at the main cancer center. Costs for each process point was determine by cost-capacity rates, and compared by treatment center location. Results: TDABC costing determined a 28.3% cost difference in ambulatory clinic visits for endometrial cancer patients, favoring treatment at the regional network location. There was no cost difference in surgery for endometrial cancer patients since all procedures were performed at main. Delivering adjuvant VBT was 44.2% more in the ambulatory regional center compared to main, primarily due to the radiation quality assurance checks at the regional site. TDABC costing determined a 39.8% cost difference in delivering PRT for intermediate risk endometrial cancer patients, favoring treatment at the regional network location. Overall, there was a 13.2% cost savings, favoring treatment at the regional cancer network location. Conclusions: Delivering care for low and intermediate risk endometrial cancer in a regional network model may represent a cost effective health care delivery method. Quality assurance checks at the regional locations are required for quality treatment delivery, however, may represent an area for cost effective process improvements or need to stratify treatment location based on complexity.