A Bootstrap Method to Estimate Cost of Behavioral Intervention Implementation: A Proof of Concept.

Objective: To develop a bootstrapping method to augment time-driven activity-based costing (TDABC) analysis intended to allow more realistic cost estimates.

Data sources: Secondary data from a multisite clinical trial conducted from 2016 to 2018 on an ostomy self-management telehealth intervention for cancer survivors.

Study design: The intervention cost was newly estimated by incorporating expected patient participation rates calculated via bootstrapping. This cost was compared against the cost estimate obtained via traditional TDABC.

Data collection: Study personnel self-reported the time spent on each activity associated with the intervention. We also utilized patient participation data collected from the trial.

Principal findings: The total cost of the telehealth intervention estimated via the bootstrapping method was $210,052.62 (95% CI: 208,652.13, 211,402.51), with an average cost per participant of $1981.63 (95% CI: 1968.42, 1994.36). Traditional TDABC analysis yielded $186,363 or $1758 per participant. Further adjusting assumptions about the cost of the postintervention monitoring phase, our approach yielded an alternative estimate of $176,362.56 (95% CI: 174,962.07, 177,712.45) and an average cost per participant of $1663.80 (95% CI: 1650.59, 1676.53) suggesting both methods yielded similar bottom-line results.

Conclusions: Incorporating bootstrapping into traditional TDABC methodology is feasible and is likely to capture variance in clinical trial data.