Despite the fact that there is a 400% discrepancy between the cheapest and most expensive health care methods to treat benign prostate hyperplasia (BPH), there are in fact no differences in its effectiveness. Those are the conclusions of new research conducted at the University of California – Los Angeles, which analyzed for the first time the costs related to the healthcare process to treat the disease using time-driven activity-based cost analysis.
The findings of the one-year research, which was published at Healthcare: The Journal of Delivery Science and Innovation, revealed that there is no evidence that the more expensive treatments also have better outcomes, as explained in a press release by the first author of the study, Alan Kaplan, who is a resident physician in the Department of Urology at UCLA.
“The rising cost of health care is unsustainable, and a big part of the problem is that health systems, health care providers and policy makers have a poor understanding of how much health care really costs,” stated Kaplan. “Until this is well understood, taxpayers, insurers and patients alike will continue to bear the burden of soaring health care costs.”
The UCLA research team used a new method based on the costs of time-driven activity, in order to understand the amount spend by UCLA to treat BPH, as well as enlarged prostate, a condition that affects almost 50% of men older than 50 years, and has different means of treatment. “We felt that if we could tackle the cost of such a complex and common condition we could use the technique to really understand cost on a larger scale,” continued the researcher.
“Most importantly, we found that within our own institution the cost of treating BPH varied about 400 percent and, as of yet, we have no proof that one way is any better than the other,” said Kaplan. “Cost can be a dirty word in medicine. People want the best health care money can buy. A poor understanding of health care costs means a lot of waste and unnecessary expenses that are borne mostly by patients. Value in health care demands high quality care at the lowest possible cost.”
Treating BPH can be made medically or through invasive procedures, which are often required in cases when medical therapies are no longer effective. The invasive procedures can range from in-office minimally invasive to outpatient surgery or inpatient open surgery, which are meant to remove the majority of prostate tissue. In addition to different procedures, there are also different pre-operative work-ups, representing a large part of the cost differential.
The investigators used the novel method of time-driven activity-based costing, created at Harvard Business School, which enables the appreciation of the cost and demand through the measurement of supplying capacity unit cost, compared with the time needed for the activity. Kaplan’s team designed a map with the treatments and each step to calculate space, product and personnel costs.
The UCLA investigators are now planning to conduct further studies to collect and examine the information relative to value in BPH, such as tests that add value to care and the ones that may be unnecessary.
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