Time-Driven Activity-Based Costing Analysis of Urological Stone Disease

Area of Science:

• Urology
• Health Economics
• Nephrolithiasis Management

Background:

• Increasing incidence of nephrolithiasis (kidney stones) in the US presents significant economic challenges.
• Time-driven activity-based costing (TDABC) is an effective method for analyzing healthcare costs.
• This study applies TDABC to evaluate four common kidney stone treatment modalities.

Purpose of the Study:

• To characterize and compare the costs of four kidney stone treatment modalities.
• To identify the primary cost drivers for each treatment approach.
• To inform future cost-effectiveness analyses in urological stone care.

Main Methods:

• Process mapping was used to detail the evaluation, treatment, and follow-up for kidney stones (<10 mm).
• Costs were calculated based on resource utilization (equipment, disposables, personnel, space) and time.
• Four treatment methods were analyzed: trial of passage, semirigid ureteroscopy, flexible ureteroscopy, and extracorporeal shock wave lithotripsy.

Main Results:

• Trial of passage ($389) was the least costly, primarily due to clinic visit expenses.
• Surgical interventions ranged in cost: extracorporeal shock wave lithotripsy ($4,367), semirigid ureteroscopy ($4,830), and flexible ureteroscopy ($5,356).
• Intraoperative disposables and personnel costs were the largest contributors to the overall expense of surgical treatments.

Conclusions:

• Conservative management of kidney stones is more cost-effective than surgical options.
• Flexible ureteroscopy represents the highest cost among the evaluated surgical interventions.
• This TDABC analysis provides valuable insights into cost drivers, aiding in improving the value and cost-effectiveness of urological care.