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

Nikhil G. Thaker; Thomas J. Pugh; Usama Mahmood; Seungtaek Choi; Tracy E. Spinks; Neil E. Martin; Terence T. Sio; Rajat J. Kudchadker; Robert S. Kaplan; Deborah A. Kuban; David A. Swanson; Peter F. Orio; Michael J. Zelefsky; Brett W. Cox; Louis Potters; Thomas A. Buchholz; Thomas W. Feeley; Steven J. Frank

doi:10.1016/j.brachy.2016.01.003

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

Nikhil G. Thaker, Thomas J. Pugh, Usama Mahmood, Seungtaek Choi, Tracy E. Spinks, Neil E. Martin, Terence T. Sio, Rajat J. Kudchadker, Robert S. Kaplan, Deborah A. Kuban, David A. Swanson, Peter F. Orio, Michael J. Zelefsky, Brett W. Cox, Louis Potters, Thomas A. Buchholz, Thomas W. Feeley, Steven J. Frank

Research output: Contribution to journal › Article › peer-review

34 Scopus citations

Abstract

Purpose: Value, 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 materials: Patients 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. Results: A 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. Conclusions: We 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.

Original language	English (US)
Pages (from-to)	274-282
Number of pages	9
Journal	Brachytherapy
Volume	15
Issue number	3
DOIs	https://doi.org/10.1016/j.brachy.2016.01.003
State	Published - May 1 2016

Keywords

Brachytherapy
Outcomes
Prostate
TDABC
Time-driven activity-based costing
Value

ASJC Scopus subject areas

Oncology
Radiology Nuclear Medicine and imaging

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Thaker, N. G., Pugh, T. J., Mahmood, U., Choi, S., Spinks, T. E., Martin, N. E., Sio, T. T., Kudchadker, R. J., Kaplan, R. S., Kuban, D. A., Swanson, D. A., Orio, P. F., Zelefsky, M. J., Cox, B. W., Potters, L., Buchholz, T. A., Feeley, T. W., & Frank, S. J. (2016). Defining the value framework for prostate brachytherapy using patient-centered outcome metrics and time-driven activity-based costing. Brachytherapy, 15(3), 274-282. https://doi.org/10.1016/j.brachy.2016.01.003

Thaker, NG, Pugh, TJ, Mahmood, U, Choi, S, Spinks, TE, Martin, NE, Sio, TT, Kudchadker, RJ, Kaplan, RS, Kuban, DA, Swanson, DA, Orio, PF, Zelefsky, MJ, Cox, BW, Potters, L, Buchholz, TA, Feeley, TW & Frank, SJ 2016, 'Defining the value framework for prostate brachytherapy using patient-centered outcome metrics and time-driven activity-based costing', Brachytherapy, vol. 15, no. 3, pp. 274-282. https://doi.org/10.1016/j.brachy.2016.01.003

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

abstract = "Purpose: Value, 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 materials: Patients 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. Results: A 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. Conclusions: We 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.",

keywords = "Brachytherapy, Outcomes, Prostate, TDABC, Time-driven activity-based costing, Value",

author = "Thaker, {Nikhil G.} and Pugh, {Thomas J.} and Usama Mahmood and Seungtaek Choi and Spinks, {Tracy E.} and Martin, {Neil E.} and Sio, {Terence T.} and Kudchadker, {Rajat J.} and Kaplan, {Robert S.} and Kuban, {Deborah A.} and Swanson, {David A.} and Orio, {Peter F.} and Zelefsky, {Michael J.} and Cox, {Brett W.} and Louis Potters and Buchholz, {Thomas A.} and Feeley, {Thomas W.} and Frank, {Steven J.}",

note = "Publisher Copyright: {\textcopyright} 2016 American Brachytherapy Society.",

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doi = "10.1016/j.brachy.2016.01.003",

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T1 - Defining the value framework for prostate brachytherapy using patient-centered outcome metrics and time-driven activity-based costing

AU - Thaker, Nikhil G.

AU - Pugh, Thomas J.

AU - Mahmood, Usama

AU - Choi, Seungtaek

AU - Spinks, Tracy E.

AU - Martin, Neil E.

AU - Sio, Terence T.

AU - Kudchadker, Rajat J.

AU - Kaplan, Robert S.

AU - Kuban, Deborah A.

AU - Swanson, David A.

AU - Orio, Peter F.

AU - Zelefsky, Michael J.

AU - Cox, Brett W.

AU - Potters, Louis

AU - Buchholz, Thomas A.

AU - Feeley, Thomas W.

AU - Frank, Steven J.

PY - 2016/5/1

Y1 - 2016/5/1

N2 - Purpose: Value, 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 materials: Patients 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. Results: A 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. Conclusions: We 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.

AB - Purpose: Value, 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 materials: Patients 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. Results: A 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. Conclusions: We 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.

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KW - Outcomes

KW - Prostate

KW - TDABC

KW - Time-driven activity-based costing

KW - Value

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

Abstract

Keywords

ASJC Scopus subject areas

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