Time-Driven Activity-Based Costing (TDBAC) Identifies Time and Effort Required for Completion of CIBMTR Forms and Can Assist in Resource Planning for HCT Centers

Purpose US transplant programs are required to report data to the Center for International Blood and Marrow Transplant Research (CIBMTR). There is, however, a lack of published data on time and effort (T/E) for completing CIBMTR Forms. A T/E analysis was performed using a Time-Driven Activity-Based Costing (TDBAC) model to determine hours needed for completion of forms. TDABC involves five distinct steps: identifying resources used for specific procedures, defining costs, estimating practice capacity, calculating cost of personnel per time unit, and determining time units required for completion, which result in the calculation of cost per procedure. Methods The adult and pediatric programs performed separate analyses including the following forms: Transplant Essential Data (TED), Comprehensive Report forms (CRF) and Cellular Therapy Essential Data (CTED). The completion period extended from pre-infusion – 1 year follow-up. Each center developed process maps for form completion and averaged out the cost per minute, per form, compensating for Clinical Research Coordinator (CRC) data entry experience. Time required to complete CIBMTR forms included chart review, data extraction, data entry, and standardized clinical consensus meetings for GVHD/Toxicity assessments, which confirmed grading and staging post-infusion. Results Time for form completion ranged 10 - 240 min, with mean/median times of 85/60, respectively (Figure 1). When analyzed by common transplant indications, total time for all form completion ranged from 933 min (leukemia) to 1083 min (immune deficiency and lymphoma). The separate process maps for adult and pediatric centers did not show notable difference in T/E. Results were then compared to CIBMTR form reimbursement. TDABC calculations determined that the actual cost is approximately up to 5 times reimbursement currently received from CIBMTR, through 1 year CRF form completion for one patient. Discussion Time analysis using TDABC can be an efficacious tool for calculating length of time to complete CIBMTR forms, and for reporting centers to justify increased reimbursement and increases in number of personnel for form completion.