The use of time-driven activity-based costing in ophthalmology: A scoping review

In healthcare economics, time-driven activity-based costing (TDABC) and activity-based costing (ABC) are increasingly utilized, yet their applications within ophthalmology remain undefined and non-standardized. A literature search was performed using the standards of Preferred Reporting Items for Systemic Reviews and Meta-Analyses extension for Scoping Reviews (PRIMSA-ScR). Studies were subjected to 3 rounds of screening, with 3 separate data extractions to summarize study characteristics, TDABC-specific parameters, and secondary or sensitivity analysis. Out of the 27 included articles, 11 utilized ABC, 12 utilized TDABC, and 4 were micro-costing studies with activity-based elements. The 2 most common ophthalmologic processes being studied were surgery only (41 %), and clinical services only (19 %). Process flow was delineated through direct observation and interviews (22 %), a mix of direct observation and electronic health record (EHR) (15 %), EHR only (11 %), direct observation only (11 %), interviews only (3.7 %) and often unspecified (37.2 %). Estimated average capacity cost rates found in TDABC articles for operating room (OR) spaces, non-OR spaces, surgeons, anesthesia, registered nurses, and other staff were reported. We observed an increase in publications utilizing activity-based costing, particularly the use of TDABC over the preceding 2 decades, with heterogenous methodologies. Standardized approaches with more detailed reporting of data sources and additional analyses are needed to increase the accessibility of TDABC in ophthalmology.