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Time Driven Activity Based Costing of Management Pathways for Vesicoureteral Reflux
Lucshman Raveendran1,2, Darius Bagli2, Fardod O'Kelly2
1Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
Insights
Vesicoureteral reflux management costs vary significantly across treatment pathways, including watchful waiting and surgical options. Time-driven activity-based costing reveals key cost drivers for pediatric urology care.
Area of Science:
- Pediatric Urology
- Health Economics
- Cost Analysis
Background:
- Vesicoureteral reflux is a common pediatric diagnosis with unpredictable management costs due to variable treatment approaches.
- Understanding institutional costs is crucial for financial planning and resource allocation in pediatric urology.
Purpose of the Study:
- To characterize the institutional costs of three distinct management pathways for pediatric vesicoureteral reflux using time-driven activity-based costing.
- To identify specific cost drivers within each management strategy.
Main Methods:
- Process maps were created for "watch and wait," minimally invasive endoscopic surgery, and open re-implantation surgery for a hypothetical pediatric patient.
- Institutional costs were calculated using capacity cost rates and resource utilization data from direct observation and electronic medical records.
Main Results:
- Total costs varied widely: "watch and wait" ($1,683.58-$2,041.12), endoscopic surgery ($2,616.35-$4,012.89), and open re-implantation ($3,317.76-$3,924.82).
- Diagnostic imaging (dimercaptosuccinic acid scans, voiding cystourethrograms) and surgical materials represented significant cost components.
- Operating room time and inpatient stay were major cost contributors for open re-implantation surgery.
Conclusions:
- Time-driven activity-based costing effectively highlights significant cost variations in vesicoureteral reflux treatment.
- Identifying local cost drivers allows for targeted interventions to optimize resource utilization and potentially reduce healthcare expenses.
Introduction:
The approach to the management of vesicoureteral reflux remains variable despite being a common pediatric diagnosis, which makes costing unpredictable. The aim of our study is to employ time driven activity based costing to characterize institutional costs of 3 management pathways for vesicoureteral reflux.
Methods:
We developed process maps for vesicoureteral reflux management based on practice guidelines applicable to a hypothetical female patient with vesicoureteral reflux index with grade 3 unilateral reflux without bowel bladder dysfunction at our institution. The costs of 3 management pathways were described, including watch and wait, minimally invasive endoscopic surgery with dextranomer/hyaluronic acid and open re-implantation surgery. Costs for each pathway were calculated using the capacity cost rate ($/minute) for institutional resources and time estimates of resource use captured through direct observation and electronic medical record data. Clinical outcomes such as the breakthrough urinary tract infections or renal scarring were not addressed in this cost description.
Results:
A substantial range of total costs ($CAD) was observed for all pathways including watch and wait ($1,683.58 to $2,041.12), minimally invasive endoscopic surgery ($2,616.35 to $4,012.89) and open re-implantation surgery ($3,317.76 to $3,924.82). Total costs for a single dimercaptosuccinic acid scan accounted for 8% to 15% of any pathway's overall costs. Material costs for voiding cystourethrogram imaging and endoscopic surgery were high at 59% and 64% to 76% of their individual total costs, respectively. For open re-implantation surgery, high costs were attributable to the longer use of operating room space and inpatient postoperative stay.
Conclusions:
Time driven activity based costing demonstrates significant cost variability in vesicoureteral reflux treatment modalities and identified local cost drivers to target. Results from this study may be used to inform future cost-effectiveness analyses.
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