In the Journals

Costs of competing treatments for low-risk prostate cancer vary widely

Significant cost variations existed between competing treatments for low-risk prostate cancer from the time of diagnosis through treatment, according to the results of a time-driven activity-based costing analysis.

These results suggest that time-driven activity-based costing (TDABC) can serve as a feasible model for analyzing cancer services and provide insight into cost-reduction options, according to the researchers.

Aaron A. Laviana

“This is the first study to truly investigate the costs of various treatments for prostate cancer over the long term,” Aaron A. Laviana, MD, a urology resident at UCLA’s David Geffen School of Medicine, said in a press release. “As we move from traditional fee-for-service reimbursement models to curb growing health care expenditures, understanding the true costs of health care is essential.”

Prior to this analysis, the costs of delivering health care to men with prostate cancer remained poorly defined, according to study background.

Thus, Laviana and colleagues from UCLA created process maps for each phase of care a man with prostate cancer could receive over the course of 12 years.

The maps began with each patient’s first urologic appointment and continued through follow-up for different treatment decisions: 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.

The active surveillance modality incorporated traditional transrectal ultrasound (TRUS) biopsy and multiparametric-MRI/TRUS fusion biopsy.

The researchers calculated the costs of materials, equipment, personnel and space per unit of time and based on the relative proportion of capacity used. They defined TDABC for each modality as the sum of its resources.

At the 5 year follow-up interval, Laviana and colleagues observed substantial variations in cost between treatment modality. Active surveillance had the lowest reported cost ($7,298), whereas IMRT had the highest ($23,565).

Cost variations remained consistent over the course of 12 years.

The researchers noted that LDR brachytherapy remained significantly less costly than HDR brachytherapy ($8,978 vs. $11,448). Further, SBRT ($11,665) was less expensive than IMRT.

The researchers attributed the disparities in cost for these procedures to shorter procedure times and fewer visits required for treatment.

Equipment costs, as well as a required inpatient stay ($2,306), contributed to the high cost of RALP ($16,946).

Cryotherapy ($11,215) appeared more costly than LDR brachytherapy, largely due to increased single-use equipment costs ($6,292 vs. $1,921).

The cost of active surveillance was equivalent to the cost of LDR brachytherapy after 7 years of follow-up.

The researchers acknowledged limitations of their study, including the use of a single institution to design their process maps, as “costs will inevitably vary between health systems according to their structural organization, provider mix, patient population and other locoregional idiosyncrasies,” the researchers wrote.

“Traditional costing methods often lack transparency and can be arbitrary, preventing the true costs of a disease or treatment from being understood,” Laviana said. “This is important, as patients often receive a hospital bill with arbitrary charges that may or may not reflect their true treatment costs. This costing methodology creates an algorithm that allows organizations to assess their costs and see where they may be able to improve. Altogether, by maintaining similar quality, this will improve the overall value of care delivered.” – by Cameron Kelsall

Disclosure: The researchers report no relevant financial disclosures.

Significant cost variations existed between competing treatments for low-risk prostate cancer from the time of diagnosis through treatment, according to the results of a time-driven activity-based costing analysis.

These results suggest that time-driven activity-based costing (TDABC) can serve as a feasible model for analyzing cancer services and provide insight into cost-reduction options, according to the researchers.

Aaron A. Laviana

“This is the first study to truly investigate the costs of various treatments for prostate cancer over the long term,” Aaron A. Laviana, MD, a urology resident at UCLA’s David Geffen School of Medicine, said in a press release. “As we move from traditional fee-for-service reimbursement models to curb growing health care expenditures, understanding the true costs of health care is essential.”

Prior to this analysis, the costs of delivering health care to men with prostate cancer remained poorly defined, according to study background.

Thus, Laviana and colleagues from UCLA created process maps for each phase of care a man with prostate cancer could receive over the course of 12 years.

The maps began with each patient’s first urologic appointment and continued through follow-up for different treatment decisions: 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.

The active surveillance modality incorporated traditional transrectal ultrasound (TRUS) biopsy and multiparametric-MRI/TRUS fusion biopsy.

The researchers calculated the costs of materials, equipment, personnel and space per unit of time and based on the relative proportion of capacity used. They defined TDABC for each modality as the sum of its resources.

At the 5 year follow-up interval, Laviana and colleagues observed substantial variations in cost between treatment modality. Active surveillance had the lowest reported cost ($7,298), whereas IMRT had the highest ($23,565).

Cost variations remained consistent over the course of 12 years.

The researchers noted that LDR brachytherapy remained significantly less costly than HDR brachytherapy ($8,978 vs. $11,448). Further, SBRT ($11,665) was less expensive than IMRT.

The researchers attributed the disparities in cost for these procedures to shorter procedure times and fewer visits required for treatment.

Equipment costs, as well as a required inpatient stay ($2,306), contributed to the high cost of RALP ($16,946).

Cryotherapy ($11,215) appeared more costly than LDR brachytherapy, largely due to increased single-use equipment costs ($6,292 vs. $1,921).

The cost of active surveillance was equivalent to the cost of LDR brachytherapy after 7 years of follow-up.

The researchers acknowledged limitations of their study, including the use of a single institution to design their process maps, as “costs will inevitably vary between health systems according to their structural organization, provider mix, patient population and other locoregional idiosyncrasies,” the researchers wrote.

“Traditional costing methods often lack transparency and can be arbitrary, preventing the true costs of a disease or treatment from being understood,” Laviana said. “This is important, as patients often receive a hospital bill with arbitrary charges that may or may not reflect their true treatment costs. This costing methodology creates an algorithm that allows organizations to assess their costs and see where they may be able to improve. Altogether, by maintaining similar quality, this will improve the overall value of care delivered.” – by Cameron Kelsall

Disclosure: The researchers report no relevant financial disclosures.