استفاده از رویکرد هزینه یابی بر مبنای فعالیت زمانگرا برای تحلیل ارزش
Abstract
Introduction
Materials and Methods
Results
Discussion
References
Abstract
Purpose: To quantify cost drivers for thoracic duct embolization based on time-driven activity-based costing methods. Materials and Methods: This was an Institutional Review Board-approved (HUM00141114) and Health Insurance Portability and Accountability Act-compliant study performed at a quaternary care institution over a 14-month period. After process maps for thoracic duct embolization were prepared, staff practical capacity rates and consumable equipment costs were analyzed via a time-driven activity-based costing methodology. Sensitivity analyses were performed to identify primary cost drivers. Results: Mean procedure duration was 4.29 hours (range: 2.15-7.16 hours). Base case cost, per case, for thoracic duct embolization was $7466.67. Multivariate sensitivity analyses performed with all minimum and maximum values for cost input variables yielded a cost range of $1001.95 (minimum) to $89,503.50 (maximum). Using local salary information and negotiated prices for materials as cost parameters, the true cost per case of thoracic duct embolization at the study institution was $8038.94. Univariate analysis demonstrated that the primary driver of staffing costs was the length of time the attending anesthesiologist was present. The predominant modifiable cost drivers included cyanoacrylate glue volume used (minimum $4467; maximum $12,467), cost of glue utilized (minimum $5217; maximum $10,467), and cost of coils utilized (minimum $7377; maximum $10,917). Univariate analysis predicted that the use of Histoacryl glue in place of TRUFILL cyanoacrylate glue resulted in a cost savings of $2947.50 per case. Conclusions: The base cost per case for thoracic duct embolization was $7466.67. Costs, namely anesthesia staffing costs, cyanoacrylate glue, and coils were large, potentially modifiable drivers of overall cost for thoracic duct embolization.
Introduction
The cost of healthcare in the United States exceeds $2.7 trillion annually, accounting for 18% of the gross domestic product.1 While increasing administrative, pharmaceutical, and home healthcare expenses are responsible for a large portion of this increase, the direct costs of providing hospital care are still the primary driver of overall healthcare costs.1-3 As providers and hospitals prepare to move from a relative value units-based system to a value-based payment system there is an increasing need to be able to determine the true costs of delivering care and services. Accurate cost accounting represents an opportunity to identify novel avenues for cost reduction in clinical interventions. Time-driven activity-based costing (TDABC) is an accounting method which has gained popularity in business and is gaining increasing prominence as a tool for estimating healthcare delivery costs.2,4-6 TDABC allows healthcare providers to measure the costs of treating patients for a specific medical or surgical condition across a full longitudinal care cycle. It uses process mapping from industrial engineering and activity-based costing from accounting.6 TDABC relies on estimates of capacity cost rates and utilization times to estimate the overall cost associated with a system or intervention.4,7 Capacity cost rate is defined as the monetary cost of a resource per unit time (in dollars per hour), calculated by dividing the total cost of a resource by the approximate time the resource is utilized.4 This may be calculated for all resources employed in a system, including staff (as wages plus benefit costs divided by hours worked), equipment (as purchase cost divided by lifetime use), and occupancy (as rental costs divided by total annual productive occupancy time).