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

Author

Listed:
  • 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
    Department of Social and Political Science, Bocconi University, 20136 Milan, Italy)

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.

Suggested Citation

  • Carla Rognoni & Alessandro Furnari & Marzia Lugli & Oscar Maleti & Alessandro Greco & Rosanna Tarricone, 2023. "Time-Driven Activity-Based Costing for Capturing the Complexity of Healthcare Processes: The Case of Deep Vein Thrombosis and Leg Ulcers," IJERPH, MDPI, vol. 20(10), pages 1-16, May.
  • Handle: RePEc:gam:jijerp:v:20:y:2023:i:10:p:5817-:d:1146297
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    References listed on IDEAS

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    4. Rosanna Tarricone & Aleksandra Torbica & Michael Drummond, 2017. "Challenges in the Assessment of Medical Devices: The MedtecHTA Project," Health Economics, John Wiley & Sons, Ltd., vol. 26, pages 5-12, February.
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