Abstract
Background
Accurate measurement of healthcare costs is required to assess and improve the value of oncology care.
Objectives
We aimed to determine the cost of breast cancer care provision across collaborating health care organizations.
Methods
We used time-driven activity-based costing (TDABC) to calculate the complete cost of breast cancer care—initial treatment planning, chemotherapy, radiation therapy, surgical resection and reconstruction, and ancillary services (e.g., psychosocial oncology, physical therapy)—across multiple hospital sites. Data were collected between December 2019 and February 2020. TDABC steps involved (1) developing process maps for care delivery pathways; (2) determine capacity cost rates for staff, medical equipment, and hospital space; (3) measure the time required for each process step, both manually through clinic observation and using data from the Real-Time Location System (RTLS); and (4) calculate the total cost of care delivery.
Results
Surgical care costs ranged from $1431 for a lumpectomy to $12,129 for a mastectomy with prepectoral implant reconstruction. Radiation therapy was costed at $1224 for initial simulation and patient education, and $200 for each additional treatment. Base costs for chemotherapy delivery were $382 per visit, with additional costs driven by chemotherapy agent(s) administered. Personnel expenses were the greatest contributor to the cost of surgical care, except in mastectomy with implant reconstruction, where device costs equated to up to 60% of the cost of surgery.
Conclusion
The cost of complete breast cancer care depended on (1) treatment protocols; (2) patient choice of reconstruction; and (3) the need for ancillary services (e.g., physical therapy). Understanding the actual costs and cost drivers of breast cancer care delivery may better inform resource utilization to lower the cost and improve the quality of care.
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Change history
21 September 2021
A Correction to this paper has been published: https://doi.org/10.1245/s10434-021-10795-4
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Acknowledgments
The authors acknowledge Eileen Joyce, Cari Ryding, and Michelle Physic for assistance in preparing the process maps, and Kaitlyn Riffenburg and Ryan Leib for support in extracting data from the RTLS system.
Funding
Dr. Navraj S. Nagra was supported by the US-UK Fulbright Commission, and the study was supported by the Patient-Reported Outcomes, Value and Experience (PROVE) Center, Department of Surgery, Brigham and Women’s Hospital, Boston, MA, USA.
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NSN, TWF, and ALP conceived and designed the study; NSN, ET, and JM conducted the study methodology; and MJH, LSD, JRB, RSK, and ALP provided oversight to the methodology. All authors reviewed the manuscript and approved the final version for submission.
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DISCLOSURE
Robert Kaplan is a compensated advisor, with cash and stock options, for Avant-garde Health. Navraj S. Nagra, Elena Tsangaris, Jessica Means, Michael J. Hassett, Laura S. Dominici, Jennifer R. Bellon, Justin Broyles, Thomas W. Feeley, and Andrea L. Pusic have no conflicts of interest to declare.
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Nagra, N.S., Tsangaris, E., Means, J. et al. Time-Driven Activity-Based Costing in Breast Cancer Care Delivery. Ann Surg Oncol 29, 510–521 (2022). https://doi.org/10.1245/s10434-021-10465-5
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DOI: https://doi.org/10.1245/s10434-021-10465-5