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An 8-step framework for implementing time-driven activity-based costing in healthcare studies


Micro-costing studies still deserving for methods orientation that contribute to achieve a patient-specific resource use level of analysis. Time-driven activity-based costing (TDABC) is often employed by health organizations in micro-costing studies with that objective. However, the literature shows many deviations in the implementation of TDABC, which might compromise the accuracy of the results obtained. One reason for that can be attributed to the non-existence of a step-by-step orientation to conduct cost analytics with the TDABC specific for micro-costing studies in healthcare. This article aimed at exploring the literature and practical cases to propose an eight-step framework to apply TDABC in micro-costing studies for health care organizations. The 8-step TDABC framework is presented and detailed exploring online spreadsheets already coded to demonstrate data structure and math formula building. A list of analyses that can be performed is suggested, including an explanation about the information that each analysis can provide to increase the organization capability to orient decision making. The case study developed show that actual micro-costing of health care processes can be achieved with the 8-step TDABC framework and its use in future researches can contribute to increase the number of studies that achieve high-quality level in cost information, and consequently, in health resource evaluation.

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This tutorial was developed by a research group from the Hospital-based Health Technology Assessment group from Hospital Moinhos de Vento. In addition to the authors, the researchers Sandro René Miguel, Veronica Colpani, Celina Borges Migliavaca, Cinara Stein, Tatiana Schnorr Silva, Dora Fraga Vargas, Luciane Kern, Isabel Bandeira and Gabriela Cardoso Bitencourt were important to achieve this result.

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Corresponding author

Correspondence to Carisi Anne Polanczyk.

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Conflict of interest

None of the authors have any conflict of interests. Supported by the Ministry of Health, Brazil, through PROADI Program, led by Hospital Moinhos de Vento, Porto Alegre, Brazil.

Ethical statement

This study has been approved by the Institutional Review Board of Hospital Moinhos de Vento of Porto Alegre (approval number 1.910.843) and by the Institutional Review Board of Hospital de Clínicas of Porto Alegre (approval number 2.035.550). Written informed consent was obtained from each participant at the time of enrollment.

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da Silva Etges, A.P.B., Cruz, L.N., Notti, R.K. et al. An 8-step framework for implementing time-driven activity-based costing in healthcare studies. Eur J Health Econ 20, 1133–1145 (2019).

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  • Micro-costing
  • Time-driven activity-based costing
  • Cost analysis
  • Healthcare costs

JEL Classification

  • I150
  • M110