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2019 SUO Annual Meeting

SUO 2019: Transperineal Versus Transrectal Ultrasound-Guided Systematic Biopsy: Understanding the True Costs Utilizing Time-Driven Activity-Based Costing

Washington, DC (UroToday.com) For the past few decades, prostate cancer diagnosis has been based on histologic diagnosis via transrectal ultrasound-guided (TRUS) prostate biopsy. However, over the past decade, there have been concerns over increasing rates of post-biopsy sepsis associated with TRUS biopsy. One of the strategies proposed to address this is a transition to transperineal from TRUS biopsy.   This has been primarily performed under general anesthetic, rather than local. This may have important cost implications. Further, there is an increasing role for multi-parametric magnetic resonance imaging (mpMRI) prior to a prostate biopsy. To assess this, Dr. Aaron Laviana and colleagues performed time-drive activity-based costing (TDABC) for a variety of prostate biopsy strategies.

The authors assessed personnel, equipment, and material costs for six prostate biopsy strategies in-office TRUS PBx, in-office template-guided TP, in-office MRI cognitive-fusion TP, in-office mp-MRI fusion-guided TRUS, in-office mp-MRI fusion-guided TP, and mp-MRI fusion-guided TP under GA. They derived capacity cost rates which were then multiplied by the relevant time associated with each aspect of the biopsy process to calculate the cumulative TDABC for each strategy.

The authors found that in operative biopsy (requiring general anesthetic) and the use of mpMRI were significant drivers of cost. The authors found that the time to perform transperineal and TRUS biopsy were similar in office (10.1 and 10.0 minutes, respectively). Similarly, transperineal and TRUS biopsy times were comparable when mpMRI fusion was performed (23 minutes and 20 minutes, respectively). Overall, time-driven activity-based costing for the six strategies was as follows: 

SUO 2019 time driven activity based costing 2

These data suggest that where feasible, transperineal and TRUS biopsy can be performed in the office with comparable costs. Further assessment of the potential for transperineal biopsy to reduce post-biopsy sepsis may improve the comparative cost efficacy of this approach.

Presented by: Aaron A Lavianam, MD, Society of Urologic Oncology Fellow, Vanderbilt University Medical Center, Nashville, Tennessee 

Written by: Christopher J.D. Wallis, MD, PhD, FRCSC Contact: @WallisCJD on Twitter at the 20th Annual Meeting of the Society of Urologic Oncology (SUO), December 4 - 6, 2019, Washington, DC