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OBJECTIVE: To determine the government and out-of-pocket community costs (out-of-hospital medical services and prescription medicines) associated with screen-detected and community-detected cancers (i.e. cancers detected outside of Australia's organised screening program [BreastScreen]). METHODS: We analyse administrative data on government-subsidised medical services and prescription medicines for 568 Victorian women diagnosed with breast cancer or ductal carcinoma in situ (DCIS). Using multivariable regression analysis, we estimate the government and out-of-pocket community costs incurred in the three years after diagnosis for screen-detected cancers and community-detected cancers. Additionally, we estimate the government costs associated with diagnosis within and outside of BreastScreen. RESULTS: Average government costs for breast cancer diagnosis were similar within and outside of BreastScreen [$808 (lower limit 676; upper limit 940) vs $837 (95%CI 671; 1,003) respectively]; however, women with community-detected cancers incurred an additional $254 (95%CI 175; 332) out-of-pocket. Controlling for differences in known cancer characteristics, compared to screen-detected cancers, community-detected breast cancers were associated with an additional $2,622 (95%CI 644; 4,776) in government expenditure in the three years following diagnosis. Adverse cancer characteristics that were more prevalent in community-detected cancers (high grade, lymph node involvement, HER2 positive receptor status) were associated with increased government and out-of-pocket costs. CONCLUSIONS: Community-detected breast cancers were associated with increased government and out-of-pocket costs. Implications for public health: These costs should be considered when evaluating current and alternative breast cancer screening strategies.

Objectives: To describe the methodology to estimate the total cost of administration of a single unit of red blood cells (RBC) in adults with beta thalassaemia major in an Australian specialist haemoglobinopathy centre. Background(s): Beta thalassaemia major is a genetic disorder of haemoglobin associated with multiple end-organ complications and typically requiring lifelong RBC transfusion therapy. New therapeutic agents are becoming available based on advances in understanding of the disorder and its consequences. Assessment of the true total cost of transfusion, incorporating both product and activity costs, is required in order to evaluate the benefits and costs of these new therapies. Method(s): We describe the bottom-up, time-driven, activity-based costing methodology used to develop process maps to provide a step-by-step outline of the entire transfusion pathway. Detailed flowcharts for each process are described. Direct observations and timing of the process maps document all activities, resources, staff, equipment and consumables in detail. The analysis will include costs associated with performing these processes, including resources and consumables. Sensitivity analyses will be performed to determine the impact of different staffing levels, timings and probabilities associated with performing different tasks. Result(s): Thirty-one process maps have been developed, with over 600 individual activities requiring multiple timings. These will be used for future detailed cost analyses. Conclusion(s): Detailed process maps using bottom-up, time-driven, activity-based costing for determining the cost of RBC transfusion in thalassaemia major have been developed. These could be adapted for wider use to understand and compare the costs and complexities of transfusion in other settings.Copyright © 2018 British Blood Transfusion Society

BACKGROUND: To accurately quantify the costs of care for patients with transfusion-dependent thalassemia (TDT), and to evaluate cost-effectiveness of new treatments, data are required on costs of regular red blood cell (RBC) transfusions. However, no previous studies have evaluated the costs of RBC transfusion specifically in chronically transfused patients. METHODS AND MATERIALS: We performed a time-driven activity-based costing (TDABC) study using a health care provider perspective. This was performed over a 1-month period, capturing every step of the transfusion pathway for patients with TDT at a designated provider of specialist thalassemia services in Australia. Detailed process maps were developed to outline treatments and processes directly related to transfusion. For each process map, detailed data collection, including timing of activities, was performed multiple times to account for variation in practice. Costs associated with RBC transfusion were broken down into fixed, process, and RBC procurement costs. RESULT(S): The total per-unit cost was US$695.59 (95% confidence interval, US$694.45-US$696.73). Approximately 40% of cost was for procurement of the RBC unit, with process costs accounting for 55%. The single largest contributor to process costs was attributed to iron chelation medication (approximately 80%). In sensitivity analyses, seniority of staff, time to perform processes, and probabilities of different processes occurring did not substantially influence the RBC transfusion cost; however the number of RBC units per transfusion episode did impact the overall cost per RBC unit. CONCLUSION(S): We found significant costs associated with RBC transfusion for TDT, with the product cost contributing less than one-half of the total cost.Copyright © 2019 AABB

Objectives: To describe the methodology to estimate the total cost of administration of a single unit of red blood cells (RBC) in adults with beta thalassaemia major in an Australian specialist haemoglobinopathy centre. Background(s): Beta thalassaemia major is a genetic disorder of haemoglobin associated with multiple end-organ complications and typically requiring lifelong RBC transfusion therapy. New therapeutic agents are becoming available based on advances in understanding of the disorder and its consequences. Assessment of the true total cost of transfusion, incorporating both product and activity costs, is required in order to evaluate the benefits and costs of these new therapies. Method(s): We describe the bottom-up, time-driven, activity-based costing methodology used to develop process maps to provide a step-by-step outline of the entire transfusion pathway. Detailed flowcharts for each process are described. Direct observations and timing of the process maps document all activities, resources, staff, equipment and consumables in detail. The analysis will include costs associated with performing these processes, including resources and consumables. Sensitivity analyses will be performed to determine the impact of different staffing levels, timings and probabilities associated with performing different tasks. Result(s): Thirty-one process maps have been developed, with over 600 individual activities requiring multiple timings. These will be used for future detailed cost analyses. Conclusion(s): Detailed process maps using bottom-up, time-driven, activity-based costing for determining the cost of RBC transfusion in thalassaemia major have been developed. These could be adapted for wider use to understand and compare the costs and complexities of transfusion in other settings.Copyright © 2018 British Blood Transfusion Society

BACKGROUND: To accurately quantify the costs of care for patients with transfusion-dependent thalassemia (TDT), and to evaluate cost-effectiveness of new treatments, data are required on costs of regular red blood cell (RBC) transfusions. However, no previous studies have evaluated the costs of RBC transfusion specifically in chronically transfused patients. METHODS AND MATERIALS: We performed a time-driven activity-based costing (TDABC) study using a health care provider perspective. This was performed over a 1-month period, capturing every step of the transfusion pathway for patients with TDT at a designated provider of specialist thalassemia services in Australia. Detailed process maps were developed to outline treatments and processes directly related to transfusion. For each process map, detailed data collection, including timing of activities, was performed multiple times to account for variation in practice. Costs associated with RBC transfusion were broken down into fixed, process, and RBC procurement costs. RESULT(S): The total per-unit cost was US$695.59 (95% confidence interval, US$694.45-US$696.73). Approximately 40% of cost was for procurement of the RBC unit, with process costs accounting for 55%. The single largest contributor to process costs was attributed to iron chelation medication (approximately 80%). In sensitivity analyses, seniority of staff, time to perform processes, and probabilities of different processes occurring did not substantially influence the RBC transfusion cost; however the number of RBC units per transfusion episode did impact the overall cost per RBC unit. CONCLUSION(S): We found significant costs associated with RBC transfusion for TDT, with the product cost contributing less than one-half of the total cost.Copyright © 2019 AABB

Background: Beta thalassaemia major is an inherited disorder of haemoglobin requiring life-long red blood cell (RBC) transfusion therapy. Information is required to understand the true costs of this support as part of overall management, and the cost-effectiveness of new treatments being developed for this condition. However, no current Australian or international data are available. Determining the true cost of trans-fusion requires a comprehensive investigation of the complex range of activities required in providing RBC support to a specific transfusion-dependent patient cohort, as various factors influence the cost (e.g. inpatient/outpatient setting), including laboratory, clinical and governance activities, and inputs required to deliver the service. Aim(s): To accurately determine the total cost of RBC transfusion support for adult transfusion-dependent thalassaemia patients at Monash Medical Centre (MMC), a thalassaemia treatment centre in Melbourne, Australia. Method(s): A time-driven activity-based costing (TD ABC) study of clinical, laboratory and administrative processes for RBC transfusions for transfusion-dependent adult thalassaemia patients at MMC was performed. Detailed process maps were developed for every procedure undertaken over 1 month (March 2017). Direct and indirect costs (personnel, consumables, equipment, clinical and testing procedures) were calculated, including costs of governance, managing long-term consequences of transfusion, and other complications. Detailed process maps and corresponding flowcharts were developed to provide a step-by-step description of the entire transfusion pathway including pre-transfusion phlebotomy, laboratory procedures, patient day admission for RBC administration, and treatments and processes directly related to the transfusion. Direct observations to verify process maps and timing of the processes were conducted. Expert opinion was obtained where processes were unable to be timed. All activities, resources

Background: Beta thalassaemia major is an inherited disorder of haemoglobin requiring life-long red blood cell (RBC) transfusion therapy. Information is required to understand the true costs of this support as part of overall management, and the cost-effectiveness of new treatments being developed for this condition. However, no current Australian or international data are available. Determining the true cost of trans-fusion requires a comprehensive investigation of the complex range of activities required in providing RBC support to a specific transfusion-dependent patient cohort, as various factors influence the cost (e.g. inpatient/outpatient setting), including laboratory, clinical and governance activities, and inputs required to deliver the service. Aim(s): To accurately determine the total cost of RBC transfusion support for adult transfusion-dependent thalassaemia patients at Monash Medical Centre (MMC), a thalassaemia treatment centre in Melbourne, Australia. Method(s): A time-driven activity-based costing (TD ABC) study of clinical, laboratory and administrative processes for RBC transfusions for transfusion-dependent adult thalassaemia patients at MMC was performed. Detailed process maps were developed for every procedure undertaken over 1 month (March 2017). Direct and indirect costs (personnel, consumables, equipment, clinical and testing procedures) were calculated, including costs of governance, managing long-term consequences of transfusion, and other complications. Detailed process maps and corresponding flowcharts were developed to provide a step-by-step description of the entire transfusion pathway including pre-transfusion phlebotomy, laboratory procedures, patient day admission for RBC administration, and treatments and processes directly related to the transfusion. Direct observations to verify process maps and timing of the processes were conducted. Expert opinion was obtained where processes were unable to be timed. All activities, resources