Motion analysis in adult spinal deformity: A time-driven activity-based costing perspective.

BACKGROUND

A novel motion analysis (MA) protocol for patients with adult spinal deformity (ASD) was developed within University Hospitals Leuven, aiming for better functional outcomes by improved treatment planning and decision making.

RESEARCH QUESTION: Can insights into the costs of a research-focused MA (RMA) protocol support the transition to a concise clinical MA (CMA) protocol and facilitate its potential adoption as standard clinical care?

METHODS

Time-driven activity-based costing (TD-ABC) was used to quantify the costs directly related to performing the MA protocol. Time durations were derived from observations and interviews and validated using time intervals retrospectively derived from previous motion analyses metadata. Costs were computed based on resource time usage and the per-minute cost of practical capacity. An expert panel then refined the RMA into a CMA protocol by excluding some trials, utilizing cost insights and insights in the potential clinical relevance of trials, including their discriminative abilities, their ability to highlight compensatory mechanisms and their standardization potential. The clinical costs of the CMA were then again calculated using the same methodology.

RESULTS

The average time to perform the RMA was 179.0 minutes and dropped to 130.9 minutes after the expert panel excluded 12 types of motion trials. The total cost of this new CMA was € 220.83. The largest cost component of the CMA was staff costs (68.1 %), followed by the cost of equipment (30.2 %).

SIGNIFICANCE: This study demonstrates how cost insights complement insights on clinical relevance when defining a motion analysis protocol for integration in standard clinical care. Future value- improvements to the protocol should also integrate insights on its impact on treatment outcome.