Time-driven activity-based costing may improve resource use in cancer care

A study done in a single institution in Singapore has demonstrated the feasibility and practical application of time-driven activity-based costing (TDABC) in measuring the financial burden of chemotherapy regimens within an ambulatory oncology setting.

For every chemotherapy regimen used, the total cost varied significantly depending on the cancer type and settings. For instance, treatment with adjuvant doxorubicin-cyclophosphamide-paclitaxel over 24 weeks for breast cancer patients cost SGD 17,075.43, which was driven by manpower utilization (2.976 man-units) and chair time (4,350.93 min). [Proc Singap Healthc 2025;doi:10.1177/20101058251355293]

In addition, metastatic docetaxel three times weekly over 6 weeks cost SGD 3,174.65, while weekly paclitaxel cost SGD 6,810.79 due to increased chair time (2,606.57 min).

For lung cancer patients, treatment with pemetrexed-carboplatin-pembrolizumab cost SGD 25,711.17, while osimertinib cost SGD 13,992.05. On the other hand, regimens for gastrointestinal cancers ranged from SGD 9,548.43 for adjuvant capecitabine-oxaliplatin to SGD 1,264.52 for palliative capecitabine.

Furthermore, the average base cost for outpatients was SGD 310 for each visit, with additional costs due to chemotherapy type, frequency, manpower, and adverse drug reaction management.

“TDABC application in oncology is limited but integral to value-based care,” the investigators said. “Understanding actual costs and cost drivers in outpatient cancer care may better inform resource use during times of constraint.”

Recommendations

Although the current care delivery model at the National Cancer Centre Singapore is efficient in several aspects, other areas may be enhanced.

Recommendations for further improvement include “standardizing time-motion tracking across regimens to ensure consistency,” “developing automated data capture from electronic medical records to reduce manual mapping burden,” and “incorporating cost-utility modelling that integrates quality-adjusted life years or progression free survival metrics into TDABS outputs.”

“Such enhancements would align Singapore’s oncology costing practices with international best practices while supporting policy shifts toward bundled payments and population-based reimbursement models,” the investigators said. [Harv Bus Rev 2011;89:46-52; BMJ 2016;352:i788]

Capacity cost

Through TDABC, a capacity cost is created for each resource used through key activities in a care process. This tool provides a blueprint to help providers make cost-conscious decisions in cancer treatment as well as other specialties.

At the institution level, TDABC helps to analyse alternative treatments while providing transparency to help in reducing the cost of treatment. At the national level, this tool can assist policymakers in cost-efficient interventions. [Harv Bus Rev 2011;89:46-52; BMJ 2016;352:i788]

“A multidisciplinary, value-added framework in the cancer care incorporating TDABC will provide oncologists, insurance payers, and institutional leaders the tools to provide value-added care at the institutional level and beyond,” the investigators said.

In this study, TDABC was used to develop process maps of the care delivery cycle, detailing each clinic or ambulatory treatment unit visit. Resources, such as supplies, personnel, and equipment, were identified at every step. Costs per minute were generated based on time requirements, while total costs were calculated by summing resource expenses for each episode of care.