Time-Driven Activity-Based Costing for Cervical Myelopathy Surgery: A Step Towards Total Episode Costs

Area of Science:

• Healthcare Economics
• Spine Surgery Cost Analysis
• Medical Procedure Costing

Background:

• Time-driven activity-based costing (TDABC) offers precise healthcare service cost determination.
• TDABC is typically applied to isolated care phases, limiting comprehensive cost analysis.
• Estimating total episode costs for surgical treatments remains a challenge.

Purpose of the Study:

• To apply TDABC to estimate the full episode costs for surgical treatment of cervical myelopathy.
• To analyze cost variations across different surgical approaches (anterior, posterior, anterior/posterior).
• To provide insights relevant to emerging condition-based bundled payment models.

Main Methods:

• A single-center retrospective study involving 63 patients undergoing elective cervical myelopathy surgery.
• TDABC was utilized to measure pre-operative, intra-operative, and post-operative inpatient costs.
• Generalized linear models and Kruskal-Wallis tests analyzed cost differences between surgical approaches.

Main Results:

• The average total episode cost for cervical myelopathy surgery was $16,488.99 ± $8,181,777.
• Anterior-posterior approaches incurred significantly higher total episode costs than anterior (p<0.001) and posterior (p<0.05) approaches.
• Anterior approaches were significantly less costly than posterior approaches (p<0.001).

Conclusions:

• TDABC is feasible for estimating comprehensive episode costs in surgical cervical myelopathy treatment.
• This study provides the first episode cost comparison across multiple surgical options for a specific spinal diagnosis.
• Surgical approach significantly impacts total episode costs, with anterior approaches being the most cost-effective.