Time-Driven Activity-Based Costing for Capturing the Complexity of Healthcare Processes: The Case of Deep Vein Thrombosis and Leg Ulcers

Carla Rognoni (), Alessandro Furnari, Marzia Lugli, Oscar Maleti, Alessandro Greco and Rosanna Tarricone
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Carla Rognoni: Centre for Research on Health and Social Care Management (CERGAS), SDA Bocconi School of Management, Bocconi University, 20136 Milan, Italy
Alessandro Furnari: Centre for Research on Health and Social Care Management (CERGAS), SDA Bocconi School of Management, Bocconi University, 20136 Milan, Italy
Marzia Lugli: National Reference Training Center in Phlebology (NRTCP), Vascular Surgery—Cardiovascular Department, Hesperia Hospital, 41125 Modena, Italy
Oscar Maleti: National Reference Training Center in Phlebology (NRTCP), Vascular Surgery—Cardiovascular Department, Hesperia Hospital, 41125 Modena, Italy
Alessandro Greco: Outpatient Wound Care Centre, Local Health Care System, 03100 Frosinone, Italy
Rosanna Tarricone: Centre for Research on Health and Social Care Management (CERGAS), SDA Bocconi School of Management, Bocconi University, 20136 Milan, Italy

IJERPH, 2023, vol. 20, issue 10, 1-16

Abstract: Time-driven activity-based costing (TDABC) is suggested to assess costs within the value-based healthcare approach, but there is a paucity of applications in chronic diseases such as deep vein thrombosis (DVT) and leg ulcers. In this context, we applied TDABC in a cost-effectiveness analysis comparing venous stenting to compression ± anticoagulation (standard of care—SOC) from both hospital and societal perspectives in Italy. TDABC was applied to both treatments to assess costs that were included in a cost-effectiveness model. Clinical inputs were retrieved from the literature and integrated with real-world data. The Incremental Cost Utility Ratio (ICUR) of stenting compared to SOC was EUR 10,270/QALY and EUR 8962/QALY for hospital and societal perspectives, respectively. The mean cost per patient for venous stenting of EUR 5082 was higher than the Diagnosis-Related Group (DRG) reimbursement (EUR 4742). For SOC, an ulcer healing in 3 months costs EUR 1892, of which EUR 302 (16%) is borne by the patient versus a reimbursement of EUR 1132. TDABC showed that venous stenting may be cost-effective compared with SOC but that reimbursement rates may not completely cover the real costs, which are partially sustained by the patients. A more efficient policy for covering the real costs may be beneficial for both clinical centers and patients.

Keywords: venous stenting; standard medical treatment; compression therapy; deep venous outflow obstruction; leg ulcers; cost-utility analysis; time driven activity-based costing (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2023
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