A study from UCD College of Business, Children's Health Ireland at Temple Street, NUI Maynooth, Harvard Business School and Boston Children's Hospital, explores the cost of outpatient cystic fibrosis (CF) care for children across Ireland and the United States.  

Recently published in NEJM Catalyst, the research demonstrates how process mapping and variance analysis can inform value-based healthcare decisions.

With rising healthcare costs within a new era of pharmacotherapy innovations that can improve quality of life and improved survival rates, understanding how multidisciplinary care models impact efficiency and expenditure is crucial.

Using a combination of time-driven activity-based costing (TDABC) together with variance analysis, the study offers new insights and ways to compare the process of care and associated costs across similar healthcare delivery operations for the care of children with CF.

It found that CF clinic visit costs vary significantly between sites, with the largest variance in the 6–17 age group. Physicians were found to be the most expensive professionals in the care process in both Ireland and the US. In the US, physicians and dietitians spent the most time with patients, whilst Clinical Nurse Specialists and dietitians did so in Ireland. 

Findings demonstrate that the amount of time spent with patients had a significant effect on cost, with more time spent with patients in Ireland than the US. Different types of clinicians providing care was also a factor, as the US had a different mix of and higher-cost providers. Furthermore, clinicians were also paid 31% more in the US than in Ireland.

The work identifies how skill mix and care structure differences impact costs, highlighting opportunities to optimise resource allocation. TDABC provided granular cost insights, allowing the researchers to pinpoint efficiency opportunities without compromising the quality of care.

Professor Gerardine Doyle, Full Professor of Accounting at UCD College of Business and a UCD Geary Institute Fellow, and Emma Brady, a PhD Student at UCD College of Business and Senior Pharmacist, Children’s Health Ireland, worked with an interdisciplinary, trans-Atlantic team from Maynooth University, Harvard Business School, Boston Children’s Hospital, Boston, Massachusetts, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts on the study.