By Eric K. Kim, M.D., and Nicole T. Jiam, M.D.

Among Organization for Economic Co‐operation and Development countries, the United States is the greatest spender on healthcare costs, yet its health outcomes are worse than those of its counterparts.

As a response, the American healthcare system has been focusing on how to better provide affordable quality healthcare. A key step in this pursuit is understanding the details and costs of a clinical program.

One cost assessment method that has been increasingly used in medical literature for this purpose is called “time-driven activity-based costing.” TDABC allows for a detailed step-by-step analysis of a process and its costs, which helps identify opportunities for reducing unnecessary costs and streamlining the process.

This approach has been successfully used in other industries, such as manufacturing and food services, and it has now been adopted to improve clinical care for patients. The objective of our study was to review how TDABC has been utilized in otolaryngology–head and neck surgery.

As published in the journal Otolaryngology–Head and Neck Surgery in December 2024, we found that TDABC has been used to study various otolaryngologic conditions, including head and neck cancer, sinus problems, sleep disorders, and swallowing difficulty.

The primary aims of TDABC articles included cutting down on unnecessary resources, comparing the costs of different treatments, and evaluating the impact of new programs designed to improve quality of care.

Some of the limitations of TDABC included potential inaccuracies and biases in the data collection and different approaches with which researchers use this methodology. It is still a growing area of research within otolaryngology, with only nine studies identified in our search and none in certain subspecialties within otolaryngology.

For example, TDABC has not been widely utilized to examine hearing care and ear surgery. However, as many otology patients often require multifaceted and resource-intensive care on a longitudinal basis, TDABC holds great potential to enhance patient care for these patients while decreasing the financial burden on the healthcare system.

As one effort to address this gap, we are currently working on a study across two different institutions to conduct TDABC analysis of personnel costs involved in cochlear implantation, with the goal of better understanding how we can make this process more efficient and affordable.

Beyond cochlear implants, we believe TDABC can be harnessed to enhance hearing care and advocate its use to further the paradigms of otology care.

The paper’s coauthors Eric K. Kim, M.D., and Nicole T. Jiam, M.D., are colleagues at the University of California, San Francisco, where Jiam is neurotology and skull base surgeon. A 2024–2025 Emerging Research Grants scientist, Jiam is the recipient of an Elizabeth M. Keithley, Ph.D. Early Stage Investigator Award, generously supported in part by Susan and Steve Kaufman.