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. 2020 May 30:23:80-84.
doi: 10.1016/j.ctro.2020.05.007. eCollection 2020 Jul.

Evaluating single-institution resource costs of consolidative radiotherapy for oligometastatic non-small cell lung cancer using time-driven activity-based costing

Todd A Pezzi  1 , Matthew S Ning  1 , Nikhil G Thaker  2 , David Boyce-Fappiano  1 , Olsi Gjyshi  1 , Nicholas D Olivieri  3 , Alexis B Guzman  4 , James R Incalcaterra  5 , Shane Mesko  1 , Saumil Gandhi  1 , Stephen Chun  1 , Chad Tang  1 , Steven J Frank  1 , Daniel R Gomez  6
Affiliations

Evaluating single-institution resource costs of consolidative radiotherapy for oligometastatic non-small cell lung cancer using time-driven activity-based costing

Todd A Pezzi et al. Clin Transl Radiat Oncol. .

Abstract

Background: Consolidative radiotherapy (RT) has been shown to improve overall survival in oligometastatic non-small cell lung cancer (NSCLC), as demonstrated by a growing number of prospective trials.

Objective: We quantified the costs of delivery of consolidative RT for common clinical pathways associated with treating oligometastatic NSCLC, by applying time-driven activity-based costing (TDABC) methodology.

Methods: Full cycle costs were evaluated for 4 consolidative treatment regimens: (Regimen #1) 10-fraction 3D conformal radiation therapy (3D-CRT) as palliation of a distant site; (#2) 15-fraction intensity-modulated RT (IMRT) to the primary thoracic disease; (#3) 15-fraction IMRT to the primary plus 4-fraction stereotactic ablative radiotherapy (SABR) to a single oligometastatic site; and (#4) 15-fraction IMRT to the primary plus two courses of 4-fraction SABR for two oligometastatic sites.

Results: For each of the four treatment regimens, personnel represented a greater proportion of total cost when compared with equipment, totaling 61.0%, 65.9%, 66.2%, and 66.4% of the total cost of each care cycle, respectively. In total, a 10-fraction regimen of 3D-CRT to a distant site represented just 37.2% of the total cost of the most expensive course. Compared to total costs for 15-fraction IMRT alone, each additional sequential course of 4-fraction SABR imparted a cost increase of 43%.

Conclusion: This analysis uses TDABC to estimate the relative internal costs of various RT strategies associated with treating oligometastatic NSCLC. This methodology will become increasingly relevant to each organization in context of the anticipated mandate of alternative/bundled payment models for radiation oncology by the Centers for Medicare and Medicaid Services.

Keywords: APM; NSCLC; Oligometastasis; Radiation; TDABC.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
Pie charts displaying the relative personnel costs involved for each treatment regimen. Note: Area of each pie chart is proportional to the total personnel cost of each treatment regimen. A = 10fx 3DCRT, B = 15fx IMRT, C = 15fx IMRT & 4fx SABR, D = 15fx IMRT & 4fx SABR (x2). Abbreviations: MD = Physician, APP = Mid-Level Provider, RN = Registered Nurse, PSC = Patient scheduling coordinator, Dosi = Dosimetrist, RTT = Radiation Therapist, MA = Medical Assistant, IMRT = intensity modulated radiation therapy, SABR = Stereotactic ablative body radiotherapy, fx = fraction.
Fig. 2
Fig. 2
Bar chart displaying the breakdown of the relative costs of each of the major and minor steps involved in each treatment regimen. Note: Percentages in each cell are relative to the total cost of Regimen #4. Abbreviations: P = Personnel cost, EQU = Equipment cost, IMRT = intensity modulated radiation therapy, SABR = Stereotactic ablative body radiotherapy, fx = fraction, CT = Computed tomography, Linac = Linear Accelerator.
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