Real-World Cost of a Bundle Payment Strategy for Thyroid Oncological 90 Days Treatment: A Time-Driven Activity-Based...

Continuous increases in the incidence of thyroid cancer emphasize the requirement for effective management policies. This study estimated the cost of a bundle reimbursement strategy for thyroid oncological treatment and compared it with a real-world cohort of patients.

This retrospective single-center microcosting study was conducted in 2 steps: (i) thyroid oncological surgery bundle design and (ii) real-world cost variability between the estimated bundle and a cohort of patients. The bundle was designed based on clinical guidelines and the center's thyroid oncological surgical experience, represented by clinical registry data on 8381 cases. Time-driven activity-based costing (TDABC) was applied to estimate the bundle's cost, using data from a real-world cohort of 29 patients. The estimated and measured cost data were compared descriptively, and cost variability was analyzed using linear multiple regression.

The thyroid cancer bundle covered care from preparation for surgery through postsurgical monitoring, including standard medications, exams, and involvement of health professionals. The estimated cost for the thyroid bundle was R$20,288 (US$3757), with the surgery accounting for 90% of the costs. The mean bundle cost based on the real-world cohort of patients was R$19,448 (SD 6690), with 33% of costs justified on hospital facilities. Patient' age and length of hospital stay were identified as cost drivers.

This study is unique in evaluating the economic impact of adopting a bundle reimbursement strategy for one thyroid cancer treatment. Applying TDABC demonstrated the value of accurate costing for evaluating pricing and increasing the chances of achieving sustainability through an innovative care and payment strategy.