MP32-10 MEASURING THE TRUE COST OF TREATING SMALL RENAL MASSES: AN ASSESSMENT OF TIME-DRIVEN ACTIVITY-BASED-COSTING

Abstract

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Practice Patterns, Cost Effectiveness IV1 Apr 2015MP32-10 MEASURING THE TRUE COST OF TREATING SMALL RENAL MASSES: AN ASSESSMENT OF TIME-DRIVEN ACTIVITY-BASED-COSTING Aaron Laviana, Chandan Kundavaram, Hung-Jui Tan, Michael Burke, Douglas Niedzwiecki, Nisheeta Setlur, Christopher Saigal, and Jim Hu Aaron LavianaAaron Laviana More articles by this author , Chandan KundavaramChandan Kundavaram More articles by this author , Hung-Jui TanHung-Jui Tan More articles by this author , Michael BurkeMichael Burke More articles by this author , Douglas NiedzwieckiDouglas Niedzwiecki More articles by this author , Nisheeta SetlurNisheeta Setlur More articles by this author , Christopher SaigalChristopher Saigal More articles by this author , and Jim HuJim Hu More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.1406AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Optimizing ‘value,’ defined as outcomes per unit cost, is the cornerstone of health care delivery reform. Integral to this platform's success is the ability to define the true costs of care. One method—time-driven activity-based costing (TDABC)— focuses on resource consumption and determines the actual expense of care by multiplying the time to perform specific tasks by the cost per unit time. This deviates from conventional methods that assume higher reimbursement equals higher expenses. We report TDABC for competing treatments of small renal masses (SRM), defined as <4cm, at a large academic center. METHODS In order to implement TDABC, we developed a process map that outlines the steps for treating a SRM (Figure 1). We then identified and calculated the costs of supplying every resource per unit time. Known as the capacity cost rate (CCR), this includes equipment and its depreciation (e.g. price/minute of the operating room table), personnel (e.g. salary/min of the clinic front desk staff), and space (e.g. cost/min to rent clinic space). We multiplied each CCR by the actual time for each step. TDABC for each intervention was defined as the sum of the products. RESULTS Robotic-assisted laparoscopic partial nephrectomy (RALPN) was the most expensive treatment for SRM, 69.7% more costly than the least costly inpatient modality, laparoscopic radical nephrectomy (LRN). Though equipment costs were more for LRN than open radical (ORN) or partial nephrectomy (OPN), the decreased personnel CCR from faster OR times (LRN 195 vs. ORN 202 vs. OPN 217 minutes) and shorter length of stay (LRN 2.4 vs. ORN 4.0 vs. OPN 3.71 days) were the primary drivers in lowering costs. Radiofrequency ablation (RFA) was 48.4% less costly than LRN, largely by avoiding inpatient costs. When performed, renal biopsy contributes significantly, adding 3.5% to the cost of RALPN vs. 12.2% to RFA. Nonetheless, it may allow for increased use of active surveillance, as it amounted to only 5.7%-9.7% of the cost of any inpatient intervention. CONCLUSIONS Although costs vary between institutions, this framework develops metrics to identify the largest contributors to cost, including CCR, which would be missed via more conventional methods. The next step is to link the costs of each intervention with outcomes to assess the value of each treatment modality. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e367-e368 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Aaron Laviana More articles by this author Chandan Kundavaram More articles by this author Hung-Jui Tan More articles by this author Michael Burke More articles by this author Douglas Niedzwiecki More articles by this author Nisheeta Setlur More articles by this author Christopher Saigal More articles by this author Jim Hu More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...