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

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.

MATERIALS AND METHODS - 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.

Brachytherapy. 2016 Feb 22 [Epub ahead of print]

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

Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX; The Institute for Cancer Care Innovation, The University of Texas MD Anderson Cancer Center, Houston, TX., Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX., Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX., Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX., Office of the SVP/Hospitals & Clinics, The University of Texas MD Anderson Cancer Center, Houston, TX., Department of Radiation Oncology, Dana-Farber Cancer Institute, Boston, MA., Department of Radiation Oncology, Mayo Clinic, Scottsdale, AZ., Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX., Harvard Business School, Boston, MA., Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX., Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX., Department of Radiation Oncology, Dana-Farber/Brigham and Women's Cancer Centers, Boston, MA., Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY., Department of Radiation Oncology, North Shore-LIJ Health System, New York, NY., Department of Radiation Oncology, North Shore-LIJ Health System, New York, NY., Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX., The Institute for Cancer Care Innovation, The University of Texas MD Anderson Cancer Center, Houston, TX; Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX., Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX.