A comparative study using time-driven activity-based costing in single-fraction breast high-dose rate brachytherapy:...

Area of Science:

• Oncology
• Radiation Therapy
• Health Economics

Background:

• Precision breast intraoperative radiation therapy (PB-IORT) is an emerging adjuvant treatment for early-stage breast cancer.
• PB-IORT delivery models vary, with some institutions using integrated brachytherapy suites and others employing distributed facilities.

Purpose of the Study:

• To compare the costs of delivering PB-IORT using time-driven activity-based costing (TDABC) across two distinct institutional models.
• To identify key cost drivers for each PB-IORT delivery model.

Main Methods:

• Process mapping was used to detail PB-IORT delivery steps, including personnel, equipment, and supplies.
• Time investment for each step was estimated, and capacity cost rates were determined.
• Total costs were calculated by multiplying cost rates by time estimates and adding product costs.

Main Results:

• PB-IORT delivery costs were lower in a distributed facility ($3,262.22) compared to an integrated brachytherapy suite ($3,996.01).
• Consumable supplies, notably the brachytherapy balloon applicator, constituted the largest cost component ($2,400) in both settings.
• Personnel costs significantly differed, being higher in the integrated suite due to increased nursing and anesthesia time.

Conclusions:

• The integrated brachytherapy suite model for PB-IORT delivery incurs higher overall costs, primarily driven by personnel expenses.
• While the disposable brachytherapy applicator is the most significant single cost, personnel and facility setup influence the total cost difference.
• Balancing cost implications with potential impacts on patient experience is crucial when selecting PB-IORT delivery models.