Improving efficiency and reducing costs of MRI-Guided prostate brachytherapy using Time-Driven Activity-Based costing

Area of Science:

• Oncology
• Health Economics
• Quality Improvement Science

Background:

• Integrated quality improvement (QI) and cost reduction strategies are crucial for enhancing value in cancer care.
• Time-driven activity-based costing (TDABC) is a detailed costing method assessing resource utilization across the entire care continuum.
• Prostate brachytherapy, particularly MRI-guided procedures, presents opportunities for workflow optimization and cost savings.

Purpose of the Study:

• To apply standard QI and TDABC methodologies to enhance workflow efficiency and decrease costs associated with MRI-guided prostate brachytherapy.
• To identify specific high-cost areas within the prostate brachytherapy care cycle.
• To implement targeted interventions for resource optimization and cost reduction.

Main Methods:

• Process mapping was used to delineate the prostate brachytherapy workflow from initial consultation to one year post-treatment, detailing resource and time requirements.
• TDABC was employed to calculate baseline costs by multiplying process times by the cost per minute of associated resources.
• Plan-do-study-act (PDSA) methodology guided the identification of workflow inefficiencies and the implementation of solutions to minimize resource consumption.

Main Results:

• The operating room (OR) represented the highest baseline cost component (40%), followed by imaging (8.7%) and consultation (7.6%).
• Targeted QI initiatives led to a reduction in OR time (from 90 to 70 min), decreasing overall costs by 5%.
• Personnel task downshifting and re-engineered follow-up protocols resulted in significant cost reductions (10% at consultation, 77% at surgery scheduling, and 8.4% for follow-up), leading to an overall 18.2% decrease in costs.

Conclusions:

• TDABC effectively complements traditional QI efforts by pinpointing costly steps, thereby focusing interventions for improved efficiency and cost reduction in cancer care.
• The integration of TDABC and QI initiatives provides a framework for understanding, communicating, and enhancing the value of cancer care services.
• These approaches are particularly relevant as healthcare payment models shift towards bundled payments, necessitating greater provider insight into cost drivers and value optimization.