The application of time-driven activity-based costing in oncology: a systematic review.

Abstract

Objectives: Time-driven activity-based costing (TD-ABC) holds promise to control costs and enhance value in oncology, but the current landscape of its applications remains uncharted. This study aims to (1) document the applications of TD-ABC in oncology and unveil its strengths and limitations, (2) assess the extent to which studies adhere to Kaplan and Porter's method, and (3) appraise study quality.

Methods: A systematic review was performed according to PRISMA guidelines. To be eligible for inclusion, studies had to provide an empirical application of TD-ABC within oncology. Structured data extraction included key characteristics such as cancer type, perspective, and analysis setting. Quality was assessed using the TD-ABC Healthcare Consortium Consensus Statement Checklist.

Results: A total of 59 studies met inclusion criteria, two-thirds of which were published within the last five years. Most studies were conducted in high-income countries and analysed common cancer types. The provider's perspective (85%) dominated, and studies typically relied on single-institution data (76%). No study assessed costs over a complete cycle of care and most focused on the costs of radiotherapy (56%) or surgery (20%). Papers generally did not adhere to the seven-step method, and average study quality was low (52%), particularly due to inadequate content in methods and results.

Conclusions: Oncology has emerged as a productive field for TD-ABC analyses, showcasing the effectiveness of TD-ABC in capturing the costs of healthcare processes where medical devices are integral to care delivery. However, concerns arise due to the overall low study quality and the lack of a consistent methodology.