Study uncovers 400% cost difference in BPH treatments

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The study shows a wide discrepancy between the least and most expensive ways to treat the common prostate condition.

When UCLA researchers used time-driven activity-based costing across an entire care process for BPH, they discovered a 400% discrepancy between the least and most expensive treatments. That’s the cost difference within UCLA, according to findings from the 1-year study.

First author Alan Kaplan, MD, said in a press release that the cost discrepancy is especially important, given the lack of proven differences in outcomes between the lower and higher cost treatments.

A leader in the men’s health field says the findings may not be generalizable to other academic and private practices.

“The rising cost of health care is unsustainable, and a big part of the problem is that health systems, health care providers and policy makers have a poor understanding of how much health care really costs,” Dr. Kaplan said. “Until this is well understood, taxpayers, insurers, and patients alike will continue to bear the burden of soaring health care costs.”

“Cost can be a dirty word in medicine. People want the best health care money can buy. A poor understanding of health care costs means a lot of waste and unnecessary expenses that are borne mostly by patients. Value in health care demands high quality care at the lowest possible cost.”

READ: Transfusion rate high with prostatectomy for BPH

Dr. Kaplan, working with Christopher Saigal, MD, and colleagues, mapped processes for UCLA’s BPH patients, including primary and specialist care in inpatient and outpatient settings. The time-driven activity-based costing method they used to estimate costs and demand is a Harvard-developed process that measures unit cost of supplying capacity and the time required to perform an activity. It takes into consideration space, product, and personnel costs.

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The researchers found that invasive diagnostic testing, which is categorized as optional in practice guidelines, can drive up costs by 150% when compared with the stand-alone urology clinic visit. The 400% discrepancy was among five different BPH surgical options.

The authors write that understanding care costs will be vital as financial risk is shifted toward providers.

To continue the work, UCLA researchers are collecting and analyzing data to determine value in BPH, including which tests add value to care and which might not.

Whether UCLA’s findings regarding BPH treatment costs are common among other academic and private practices is doubtful, at this time, Steven A. Kaplan, MD, of Weill Cornell Medical College and New York Presbyterian Hospital in New York, writes in an email to Urology Times, where he serves as an Editorial Council member.

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“The study assesses various costs but not outcomes,” he said. “Ultimately, the real question is: Does diagnostic efficiency and cost contribute to ‘therapeutic efficacy’ and outcomes? If more tests and/or costs increase therapeutic efficacy and reduce downstream costs, then this is justified. If they do not, then studies like these will be helpful in guiding algorithms. My sense is that, for some, more tests do not contribute to better results and, for others, they do.

“We can use these metrics to ascertain diagnostic and therapeutic areas of excellence in all aspects of medical care-not just BPH.”

The study is published in Healthcare: The Journal of Delivery Science and Innovation (2015; 3:43–8).

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