Using Time-Drive Activity-Based Costing in a Cost Analysis of Whole Brain Radiation Therapy Using Clinical Setup Versus CT Simulation Planning

Abstract

Efficiency and cost-control in today’s healthcare system has become increasingly important. Accurate analyses to determine the most cost-efficient treatment techniques are essential. Time Driven Activity Based Costing (TDABC) simply and precisely determines costs of a process by accounting for all resources and utilities provided during each step and assigning a cost per time. We applied TDABC to compare Whole Brain Radiotherapy (WBRT) using CT simulation against WBRT using clinical setup. Our hypothesis is that WBRT with clinical setup is more cost-efficient than using CT Simulation for planning. Using the TDABC method, we created process maps to delineate the independent steps in WBRT (30Gy/10fx) for inpatient consultations using CT Simulation for treatment planning versus clinical setup. Through staff interviews and departmental consensus, we estimated the timing of each step from initial consultation through post-treatment billing. Capacity cost rates (CCR, in cost per minute) were determined for personnel, materials, physical space, and equipment. Total cost of each step was computed by multiplying the CCR by time required of each resource during the step. Lastly, total Process Cost was calculated by summating the costs of each step in combination with disposable materials. Clinical setup WBRT resulted in a total cost which was 77% of the total cost using CT Simulation. For CT Simulation, cost comprised of 57% personnel costs, 36% space/equipment costs, and 7% material costs. Clinical setup comprised of 62% personnel costs and 38% space/equipment costs. With CT Simulation, the extra appointment, personnel, planning, and machine usage resulted in a probability weighted time which was 90 minutes longer than using clinical setup. The most expensive activity was attending physician time spent with patient in consultation which was the same between the two pathways. Attending physicians had the highest CCR ($4.28/min). Clinical setup for whole brain radiotherapy resulted in a 23% absolute reduction in total cost compared with CT Simulation for treatment planning. Consideration of cost difference should be given when considering using CT Simulation for inpatient palliative WBRT. Future investigations should use TDABC to better understand expenditures through appropriately accounting for consumed resources.