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Article | Brachytherapy

Defining the Value Framework for Prostate Brachytherapy Using Patient-Centered Outcome Metrics and Time-Driven Activity-Based Costing

by N.G. Thaker, T.J. Pugh, U. Mahmood, S. Choi, T.E. Spinks, N.E. Martin, T.T. Sio, R.J. Kudchadker, R. S. Kaplan, D.A. Kuban, D.A. Swanson, P.F. Orio, M.J. Zelefsky, B.W. Cox, L. Potters, T.A. Buchholz, T.W. Feeley and S.J. Frank

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Abstract

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. METHODS AND MATERIALS: 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.

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Citation:

Thaker, N.G., T.J. Pugh, U. Mahmood, S. Choi, T.E. Spinks, N.E. Martin, T.T. Sio, R.J. Kudchadker, R. S. Kaplan, D.A. Kuban, D.A. Swanson, P.F. Orio, M.J. Zelefsky, B.W. Cox, L. Potters, T.A. Buchholz, T.W. Feeley, and S.J. Frank. "Defining the Value Framework for Prostate Brachytherapy Using Patient-Centered Outcome Metrics and Time-Driven Activity-Based Costing." Brachytherapy 15, no. 3 (May–June 2016): 274–282.

About the Authors

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Robert S. Kaplan
Senior Fellow, Marvin Bower Professor of Leadership Development, Emeritus
Accounting and Management

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Thomas W. Feeley
Senior Fellow

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  • Case | HBS Case Collection | November 2019

    Martini Klinik: Prostate Cancer Care 2019

    Michael E. Porter, Jens Deerberg-Wittram and Thomas W. Feeley

    Since its establishment in 2005, Hamburg’s Martini Klinik had single-mindedly focused on prostate cancer care with a commitment to measure long term health outcomes for every patient. A wholly owned subsidiary of the University Hospital Hamburg, Martini Klinik was a “hospital in a hospital” in close proximity to other medical departments and services. By 2019, Martini Klinik had become the largest prostate cancer treatment program in the world with 8,000 outpatient cases and more than 2,500 surgical cases annually. Patients came from all over Germany and from around the world. A new and expanded facility was under construction to have the capacity to manage more patients with prostate cancer.

    Keywords: health care; Michael Porter; Jens Deerberg-Wittram; Clifford Marks; prostate cancer; health care policy; value agenda; integrated practice units; outcomes measurement; Health Care and Treatment; Value; Health Disorders; Insurance; Medical Specialties; Outcome or Result; Measurement and Metrics; Business Processes; Insurance Industry; Health Industry; Germany;

    Citation:

    Porter, Michael E., Jens Deerberg-Wittram, and Thomas W. Feeley. "Martini Klinik: Prostate Cancer Care 2019." Harvard Business School Case 720-359, November 2019.  View Details
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  • Working Paper | HBS Working Paper Series | 2019

    Intelligent Design of Inclusive Growth Strategies

    Robert S. Kaplan, George Serafeim and Eduardo Tugendhat

    Improving corporate engagement with society, as advocated in the Business Roundtable’s 2019 statement, should not be viewed as a zero-sum proposition where attention to new stakeholders detracts from delivering shareholder value. Corporate programs for sustainable and ethical sourcing practices, however, have fallen far short of solving the underlying causes of extreme poverty, extensive use of child labor, and threats to the environment and human health. We identify several causes to explain this disappointing shortfall in societal performance, including traditional company policies and incentives that inhibit the implementation of innovative, inclusive growth strategies. We propose the role for a new actor, a catalyst, to help companies forge new relationships with external funders, local intermediary companies, NGOs, and community leaders. The catalyst aligns the multiple stakeholders from multiple sectors into enduring, mutually beneficial relationships that produce more value than that currently produced when stakeholders connect only by transactional relationships. The catalyst attracts funding from public and private sources to invest in the new ecosystem, which can generate attractive financial returns while alleviating poverty and environmental degradation. Finally, the catalyst engages the multiple participants to collectively co-create explicit strategies and scorecards of metrics, which serve to motivate, create accountability, and enable an enduring governance model for a multi-stakeholder ecosystem.

    Keywords: inclusion; sustainability; performance measures; Environmental Sustainability; Social Issues; Strategy; Governance; Corporate Social Responsibility and Impact; Business and Stakeholder Relations;

    Citation:

    Kaplan, Robert S., George Serafeim, and Eduardo Tugendhat. "Intelligent Design of Inclusive Growth Strategies." Harvard Business School Working Paper, No. 20-050, October 2019.  View Details
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  • Article | NEJM Catalyst

    Achieving Value in Highly Complex Acute Care: Lessons from the Delivery of Extra Corporeal Life Support

    Michael Nurok, Jonathan Warsh, Erik Dong, Jeffrey Lopez, Mayumi Kharabi and Robert S. Kaplan

    We applied a value (outcomes and cost) analysis to extracorporeal life support (ECLS), a relatively rare but very expensive ICU therapy with highly variable outcomes. To address the outcome component of the value approach, we created guidelines for ECLS delivery; to address the cost component, we applied time-driven activity-based costing to identify opportunities for more efficient care. We learned that patient and family preferences for more humane and sensitive end-of-life care, if respected, will lead to less intensive use of ICU resources. Patients will have outcomes concordant with their goals and preferences, and society incurs lower costs to help them achieve those preferences. Cost reduction can be achieved by increasing efficiencies in the delivery of care and minimizing care outside of locally developed appropriate use guidelines. Reducing ECLS demands on ICU resources allows these resources to be redeployed to patients who are more likely to benefit from them, which also helps the institution financially.

    Keywords: Health Care and Treatment; Cost Management; Value; Analysis;

    Citation:

    Nurok, Michael, Jonathan Warsh, Erik Dong, Jeffrey Lopez, Mayumi Kharabi, and Robert S. Kaplan. "Achieving Value in Highly Complex Acute Care: Lessons from the Delivery of Extra Corporeal Life Support." NEJM Catalyst (October 31, 2019).  View Details
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