A feasibility study using time-driven activity-based costing as a management tool for provider cost estimation: lessons from the national TB control program in Zimbabwe in 2018

Abstract

Background Insufficient cost data and limited capacity constrains the understanding of the actual resources required for effective TB control. This study used process maps and time-driven activity-based costing to document TB service delivery processes. The analysis identified the resources required to sustain TB services in Zimbabwe, as well as several opportunities for more effective and efficient use of available resources. Methods A multi-disciplinary team applied time-driven activity-based costing (TDABC) to develop process maps and measure the cost of clinical pathways used for Drug Susceptible TB (DS-TB) at urban polyclinics, rural district and provincial hospitals, and community based targeted screening for TB (Tas4TB). The team performed interviews and observations to collect data on the time taken by health care worker-patient pairs at every stage of the treatment pathway. The personnel’s practical capacity and capacity cost rates were calculated on five cost domains. An MS Excel model calculated diagnostic and treatment costs. Findings Twenty-five stages were identified in the TB care pathway across all health facilities except for community targeted screening for TB. Considerable variations were observed among the facilities in how health care professionals performed client registration, taking of vital signs, treatment follow-up, dispensing medicines and processing samples. The average cost per patient for the entire DS-TB care was USD324 with diagnosis costing USD69 and treatment costing USD255. The average cost for diagnosis and treatment was higher in clinics than in hospitals (USD392 versus USD256). Nurses in clinics were 1.6 time more expensive than in hospitals. The main cost components were personnel (USD130) and laboratory (USD119). Diagnostic cost in Tas4TB was twice that of health facility setting (USD153 vs USD69), with major cost drivers being demand creation (USD89) and sputum specimen transportation (USD5 vs USD3). Conclusion TDABC is a feasible and effective costing and management tool in low-resource settings. The TDABC process maps and treatment costs revealed several opportunities for innovative improvements in the NTP under public health programme settings. Re-engineering laboratory testing processes and synchronising TB treatment follow-up with antiretroviral treatments could produce better and more uniform TB treatments at significantly lower cost in Zimbabwe.

Implementation Activity-Based Costing & Time-Driven Activity-Based Costing: A Systematic Literature Review

“…TDABC is a workable management technique for analyzing and pricing care processes in public health initiatives with limited funding. (Chirenda et al, 2021;Defourny et al, 2023). When used to focus improvement possibilities on patient care pathways, TDABC users demonstrate that this approach is always satisfying, resulting in cost savings and occasionally better treatment designs.…”

From centralized DRG costing to decentralized TDABC-assessing the feasibility of hospital cost accounting for decision-making in Denmark

“…There is a growing body of literature investigating the phenomenon of value-based healthcare initiatives in hospitals [23,25,26,35,36], which particularly focuses on the more strategic elements of providing services from a patient perspective [35][36][37]. Another stream of literature focuses on the implementation of TDABC in relation to VBHC [7,16,27,28,38], where most of these studies have to narrow the scope of study down to department or facility level to comprehend the complexity [38,39]. The TDABC approach is a simplified and extended strategy of the traditional activity-based costing (ABC) approach introduced as a costing method in hospitals during the 1990s and 2000s [40][41][42][43].…”

Activity-based costing (ABC) in SMEs and innovative initiatives: possible option or expired?

“…Estudios recientes sostienen que la detección rápida y precisa de la tuberculosis (TBC) es indispensable para mejorar el diagnóstico del paciente y reducir la transmisión de la enfermedad; por lo que, al igual que el tratamiento, resultó ser más eficaz el uso de la determinación de los precios de tratamiento calculados con base en el costo medio utilizando el costeo basado en actividades (ABC), costos determinados que resultaron ser significativamente menores que los sistemas tradicionales, atendidos con un equipo multidisciplinario. Consiguientemente, el sistema ABC permitió también cuantificar costos de entrevistas y observaciones a los trabajadores de la salud incluido sus pacientes en cada etapa de la vía de tratamiento, para así evaluar los niveles de satisfacción y, consecuentemente, administrar la priorización, planificación, presupuestación operativa, evaluación económica de programas, intervención y manejo de enfermedades (Bay et al, 2017;Chirenda et al, 2021;Figueredo et al, 2020).…”