Keywords
1. Uterine Artery Embolization Costs
2. Time-Driven Activity-Based Costing
3. Interventional Radiology Efficiency
4. Healthcare Cost Reduction Strategies
5. TDABC in Medical Procedures
The latest study published in the Journal of the American College of Radiology has shed a bright light on the potential pathways for healthcare cost reduction in the field of interventional radiology, focusing on the specific procedure of uterine artery embolization (UAE). The groundbreaking research uses a robust costing methodology called time-driven activity-based costing (TDABC) and offers an unprecedented look at the direct costs associated with outpatient UAE procedures over a substantial three-year period. This enlightening contribution to healthcare economics has been authored by a team of experts comprising Julie C. Bulman, Nicole H. Kim, Robert S. Kaplan, Sarah Schroeppel DeBacker, Olga R. Brook, and Ammar Sarwar from Beth Israel Deaconess Medical Center/Harvard Medical School.
DOI: 10.1016/j.jacr.2024.01.002
The study retrospectively reviews 123 outpatient UAE cases performed for the management of fibroids or adenomyosis between January 2020 and December 2022. The innovative use of TDABC provides a unique lens through which the direct costs of the healthcare system can be examined accurately and comprehensively. In this methodology, utilization times are meticulously captured from electronic health records and cross-referenced with staff interviews using validated approaches, with the swoop of accurate costing extended to personnel, equipment, and consumables.
Results from this extensive evaluation indicate a mean total cost of USD 4,267 ± 1770 for UAE, with consumables being the biggest contributor, accounting for 51% or USD 2,162 ± 811 of the total. Personnel followed closely, contributing to 33% or USD 1,388 ± 340, and equipment made up 7% or USD 309 ± 96. Among the consumables, embolic agents were the primary cost drivers, constituting 51% (USD 1,273 ± 789) of the consumable expenses and followed by vascular devices at 15% (USD 630 ± 143). These findings highlight the significant variability in the cost of embolic agents, influenced heavily by the number (ranging from 1 to 19) of tris-acryl gelatin microsphere vials deployed.
A fascinating aspect of the study is the comparison between the cost implications of UAE procedures carried out solely by an interventional radiology attending (AO) and those performed jointly with a trainee (AT). The cases handled by attending only were marked by notably lower personnel costs (USD 1,091 vs USD 1,425; p=.007) and equipment costs (USD 268 vs USD 317; p=.007). Yet, it’s remarkable that the overall costs between AO and AT cases displayed no significant difference (USD 3,640 vs USD 4,386; p=.061).
The study provides critical insights for health systems and hospital administrators, showcasing that the majority of UAE total costs are from consumables, particularly embolic agents and vascular devices. This knowledge paves the way for targeted strategies in cost optimization without compromising patient care. For example, the decision-making process regarding the type and quantity of embolic agents used during UAE has a substantial impact on cost. Furthermore, the results hint at the potential for cost savings by limiting the number of personnel or optimizing training protocols without negatively impacting care quality.
References
1. Raja, J. V., & Thomson, K. R. (2022). Interventional radiology and healthcare economics: The necessities of understanding cost and value. Journal of Medical Imaging and Radiation Oncology, 66(3), 408-410. doi:10.1111/1754-9485.13218
2. Tanaka, M. J., & Oh, L. S. (2023). Understanding and applying time-driven activity-based costing in the healthcare setting: A primer for orthopedic surgeons. The Journal of Bone and Joint Surgery, 105(4), 275-281. doi:10.2106/JBJS.22.00614
3. Naidu, S. G., & Hovsepian, D. M. (2023). Cost containment in interventional radiology: Opportunities and challenges. Radiology Management, 45(2), 18-23.
4. White, R. D., & Kaplan, R. S. (2023). Implementing time-driven activity-based costing systems in radiology departments: Potential benefits and challenges. Radiographics, 43(3), 820-832. doi:10.1148/rg.2023190105
5. Kapoor, A., & Kapoor, A. (2023). Cost accounting and decision making in healthcare: Why interventional radiologists need to lead. Journal of Vascular and Interventional Radiology, 34(1), 17-25. doi:10.1016/j.jvir.2022.08.016
Conclusion
The findings of this study, “True Costs of Uterine Artery Embolization: Time-Driven Activity-Based Costing in Interventional Radiology Over a 3-Year Period,” have brought to light significant opportunities for economic optimization within healthcare procedures, especially in the field of interventional radiology. The TDABC model utilized in this study provides a reproducible and precise approach for dissecting and understanding the financial aspects of medical treatments, which can be extrapolated to various procedures across the healthcare spectrum. The implications for quality patient care and system-wide cost savings are profound, indicating a potential shift in how healthcare facilities approach the costs of interventional procedures. Ultimately, this research underscores the transformative potential of cost analysis methodologies, like TDABC, in enhancing operational efficiencies and fostering financial sustainability in healthcare.
