Activity-Based Costing of Intensity-Modulated Proton versus Photon Therapy for Oropharyngeal Cancer

Nikhil G. Thaker, MD; David Boyce-Fappiano, MD; Matthew S. Ning, MD; Dario Pasalic, MD; Alexis Guzman, MBA; Grace Smith, MD, PhD, MPH; Emma B. Holliday, MD; James Incalcaterra, PhD; Adam S. Garden, MD; Simona F. Shaitelman, MD; G. Brandon Gunn, MD; C. David Fuller, MD, PhD; Pierre Blanchard, MD; Thomas W. Feeley, MD; Robert S. Kaplan, PhD; Steven J. Frank, MD

doi:10.14338/IJPT-20-00042.1

International Journal of Particle Therapy (Jun 2021)

Activity-Based Costing of Intensity-Modulated Proton versus Photon Therapy for Oropharyngeal Cancer

Nikhil G. Thaker, MD,
David Boyce-Fappiano, MD,
Matthew S. Ning, MD,
Dario Pasalic, MD,
Alexis Guzman, MBA,
Grace Smith, MD, PhD, MPH,
Emma B. Holliday, MD,
James Incalcaterra, PhD,
Adam S. Garden, MD,
Simona F. Shaitelman, MD,
G. Brandon Gunn, MD,
C. David Fuller, MD, PhD,
Pierre Blanchard, MD,
Thomas W. Feeley, MD,
Robert S. Kaplan, PhD,
Steven J. Frank, MD

Affiliations

Nikhil G. Thaker, MD: 1 Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
David Boyce-Fappiano, MD: 1 Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
Matthew S. Ning, MD: 1 Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
Dario Pasalic, MD: 1 Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
Alexis Guzman, MBA: 3 The Institute for Cancer Care Innovation, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
Grace Smith, MD, PhD, MPH: 1 Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
Emma B. Holliday, MD: 1 Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
James Incalcaterra, PhD: 3 The Institute for Cancer Care Innovation, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
Adam S. Garden, MD: 1 Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
Simona F. Shaitelman, MD: 1 Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
G. Brandon Gunn, MD: 1 Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
C. David Fuller, MD, PhD: 1 Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
Pierre Blanchard, MD: 1 Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
Thomas W. Feeley, MD: 4 Harvard Business School, Boston, MA, USA
Robert S. Kaplan, PhD: 4 Harvard Business School, Boston, MA, USA
Steven J. Frank, MD: 1 Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

DOI: https://doi.org/10.14338/IJPT-20-00042.1
Journal volume & issue: Vol. 8, no. 1
pp. 374 – 382

Abstract

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Purpose: In value-based health care delivery, radiation oncologists need to compare empiric costs of care delivery with advanced technologies, such as intensity-modulated proton therapy (IMPT) and intensity-modulated radiation therapy (IMRT). We used time-driven activity-based costing (TDABC) to compare the costs of delivering IMPT and IMRT in a case-matched pilot study of patients with newly diagnosed oropharyngeal (OPC) cancer. Materials and Methods: We used clinicopathologic factors to match 25 patients with OPC who received IMPT in 2011-12 with 25 patients with OPC treated with IMRT in 2000-09. Process maps were created for each multidisciplinary clinical activity (including chemo-therapy and ancillary services) from initial consultation through 1 month of follow-up. Resource costs and times were determined for each activity. Each patient-specific activity was linked with a process map and TDABC over the full cycle of care. All calculated costs were normalized to the lowest-cost IMRT patient. Results: TDABC costs for IMRT were 1.00 to 3.33 times that of the lowest-cost IMRT patient (mean ± SD: 1.65 ± 0.56), while costs for IMPT were 1.88 to 4.32 times that of the lowest-cost IMRT patient (2.58 ± 0.39) (P < .05). Although single-fraction costs were 2.79 times higher for IMPT than for IMRT (owing to higher equipment costs), average full cycle cost of IMPT was 1.53 times higher than IMRT, suggesting that the initial cost increase is partly mitigated by reductions in costs for other, non-RT supportive health care services. Conclusions: In this matched sample, although IMPT was on average more costly than IMRT primarily owing to higher equipment costs, a subset of IMRT patients had similar costs to IMPT patients, owing to greater use of supportive care resources. Multidimensional patient outcomes and TDABC provide vital methodology for defining the value of radiation therapy modalities.

Published in International Journal of Particle Therapy

ISSN: 2331-5180 (Online)
Publisher: Elsevier
Country of publisher: Netherlands
LCC subjects: Medicine: Medicine (General): Medical physics. Medical radiology. Nuclear medicine; Science: Physics: Nuclear and particle physics. Atomic energy. Radioactivity
Website: https://www.sciencedirect.com/journal/international-journal-of-particle-therapy

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