Evaluation of delivery costs for external beam radiation therapy and brachytherapy for locally advanced cervical cancer using time-driven activity-based costing

Publication date: Available online 14 September 2017
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Kristine Bauer-Nilsen, Colin Hill, Daniel M. Trifiletti, Bruce Libby, Donna H. Lash, Melody Lain, Deborah Christodoulou, Constance Hodge, Timothy N. Showalter
PurposeThis study aims to evaluate the delivery costs, using time-driven activity-based costing (TDABC), and reimbursement for definitive radiation therapy for locally advanced cervical cancer.Methods and MaterialsProcess maps were created to represent each step of the radiation treatment process and included personnel, equipment, and consumable supplies used to deliver care. Personnel were interviewed to estimate time involved to deliver care. Salary data, equipment purchasing information and facilities costs were also obtained. We defined the capacity cost rate (CCR) for each resource, and then calculated the total cost of patient care based upon CCR and time for each resource. Costs were compared to 2016 Medicare reimbursement and relative value units (RVUs).ResultsThe total cost of radiation therapy for cervical cancer was $12,861.68, with personnel costs comprising 49.8%. Brachytherapy cost $8,610.68 (66.9% of total) and consumed 423 minutes of attending radiation oncologist time (80.0% of total). EBRT cost $4,055.01 in costs (31.5% of total). Personnel costs were higher for brachytherapy than for the sum of simulation and EBRT delivery ($4,798.73 vs. $1,404.72). A full radiation therapy course provides radiation oncologists 149.77 RVUs with IMRT or 135.90 RVUs with 3DCRT, with total reimbursement of $23,321.71 and $16,071.90 respectively. Attending time per RVU is approximately 4-fold higher for brachytherapy (5.68 minutes) than 3DCRT (1.63 minutes) or IMRT (1.32 minutes).ConclusionTDABC was used to calculate the total cost of definitive radiation therapy for cervical cancer, revealing that brachytherapy delivery and personnel resources comprised the majority of costs. However, current reimbursement policy does not reflect the increased attending physician effort and delivery costs of brachytherapy. We hypothesize that the significant discrepancy between treatment costs and physician effort versus reimbursement may be a potential driver of reported national trends towards poor compliance with brachytherapy and suggest re-evaluation of payment policies to incentivize quality care.

Teaser

Time-driven activity-based costing methodology was applied to calculate the delivery costs of definitive radiation therapy for locally advanced cervical cancer. Brachytherapy was more costly and consumed more attending radiation oncologist time than external beam radiation therapy. Comparison of the delivery costs and physician time requirements to current reimbursement revealed a financial disincentive against brachytherapy, which should be studied as a potential contributor to the reported national poor compliance rates for cervical cancer brachytherapy.


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