Same outcomes, 400 percent difference in cost.
Those were the findings of a study by UCLA researchers who examined the various treatment pathways for a fairly common condition known as benign prostate hyperplasia, better known as an enlarged prostate. The condition, which causes difficulty with urinating, affects about half of all men older than 50, and rises to about 90 percent among men once they reach 80.
The researchers used a technique known as time-driven activity based costing--measuring the amount of time an activity takes and correlating to it a specific cost.
There are a variety of ways to treat an enlarged prostate, which range from drug treatments to minimally invasive surgery to full surgery. The outcomes for all of the patients with the condition were about the same, regardless of the treatment regimen, according to the study, However, the costs varied significantly, according to the study, which was published in the most recent issue of Healthcare: The Journal of Delivery Science and Innovation.
"Cost can be a dirty word in medicine. People want the best healthcare money can buy," said Alan Kaplan, M.D., a resident physician in the UCLA Department of Urology and the lead author of the study, in a study announcement. "A poor understanding of healthcare costs means a lot of waste and unnecessary expenses that are borne mostly by patients. Value in healthcare demands high-quality care at the lowest possible cost."
Kaplan noted that if researchers were able to find significant cost variations in a complex treatment such as joint replacement surgery--where costs can vary by as much as $20,000--it could also be found in treatments for simpler conditions such as an enlarged prostate. The cost of space, related medical products and staff were factored into the study.
Some payers have turned to reference pricing--capping what is paid for a procedure--as a way of controlling costs, although the emphasis is placed on outcomes rather than financial efficiency.
One of the biggest findings involves the use of mostly optional invasive diagnostic testing, Although most practice guidelines consider its use optional, it can increase costs by 150 percent when compared to a simple urological office visit.
The study also concluded that organizations can use time-driven activity-based costing to measure cost across an entire care pathway in any hospital, including an academic medical center.