Defining the value framework for prostate brachytherapy using patient-centered outcome metrics and time-driven activity-based costing

• Published in: Brachytherapy Vol. 15; no. 3; pp. 274 - 282
• Main Authors: Thaker, Nikhil G, Pugh, Thomas J, Mahmood, Usama, Choi, Seungtaek, Spinks, Tracy E, Martin, Neil E, Sio, Terence T, Kudchadker, Rajat J, Kaplan, Robert S, Kuban, Deborah A, Swanson, David A, Orio, Peter F, Zelefsky, Michael J, Cox, Brett W, Potters, Louis, Buchholz, Thomas A, Feeley, Thomas W, Frank, Steven J
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-05-2016
• Subjects: Aged; Aged, 80 and over; Brachytherapy; Brachytherapy - adverse effects; Brachytherapy - economics; Cost-Benefit Analysis - methods; Data Display; Disease-Free Survival; Follow-Up Studies; Health Care Costs; Hematology, Oncology, and Palliative Medicine; Humans; Magnetic Resonance Imaging - economics; Male; Middle Aged; Neoplasm Recurrence, Local - etiology; Outcomes; Patient Reported Outcome Measures; Patient-Centered Care; Prostate; Prostate-Specific Antigen; Prostatic Neoplasms - diagnostic imaging; Prostatic Neoplasms - radiotherapy; Radiology; Survival Rate; TDABC; Time Factors; Time-driven activity-based costing; Treatment Outcome; Value; Value; Brachytherapy; Time-driven activity-based costing; Prostate; TDABC; Outcomes
• ISSN: 1538-4721; 1873-1449; 1873-1449
• DOI: 10.1016/j.brachy.2016.01.003

AbstractPurposeValue, defined as outcomes over costs, has been proposed as a measure to evaluate prostate cancer (PCa) treatments. We analyzed standardized outcomes and time-driven activity-based costing (TDABC) for prostate brachytherapy (PBT) to define a value framework. Methods and materialsPatients with low-risk PCa treated with low-dose-rate PBT between 1998 and 2009 were included. Outcomes were recorded according to the International Consortium for Health Outcomes Measurement standard set, which includes acute toxicity, patient-reported outcomes, and recurrence and survival outcomes. Patient-level costs to 1 year after PBT were collected using TDABC. Process mapping and radar chart analyses were conducted to visualize this value framework. ResultsA total of 238 men were eligible for analysis. Median age was 64 (range, 46–81). Median followup was 5 years (0.5–12.1). There were no acute Grade 3–5 complications. Expanded Prostate Cancer Index Composite 50 scores were favorable, with no clinically significant changes from baseline to last followup at 48 months for urinary incontinence/bother, bowel bother, sexual function, and vitality. Ten-year outcomes were favorable, including biochemical failure-free survival of 84.1%, metastasis-free survival 99.6%, PCa-specific survival 100%, and overall survival 88.6%. TDABC analysis demonstrated low resource utilization for PBT, with 41% and 10% of costs occurring in the operating room and with the MRI scan, respectively. The radar chart allowed direct visualization of outcomes and costs. ConclusionsWe successfully created a visual framework to define the value of PBT using the International Consortium for Health Outcomes Measurement standard set and TDABC costs. PBT is associated with excellent outcomes and low costs. Widespread adoption of this methodology will enable value comparisons across providers, institutions, and treatment modalities.