To read the full version of this content please select one of the options below:

Relationship between patient costs and patient pathways

Sara Dahlin (Department of Technology Management and Economics, Chalmers University of Technology, Gothenburg, Sweden)
Hendry Raharjo (Department of Technology Management and Economics, Chalmers University of Technology, Gothenburg, Sweden)

International Journal of Health Care Quality Assurance

ISSN: 0952-6862

Article publication date: 11 February 2019




The purpose of this paper is to identify actual (as-is) patient pathway variation among breast cancer patients and to investigate the relationship between pathways and the cost incurred by patients.


Both quantitative and qualitative methods were employed to analyze data from four Swedish hospital groups. Quantitative methods include event-log data mining and statistical analyses on the related patient cost from the Swedish breast cancer quality registry and case-costing system. Qualitative methods included collaboration with and interviewing domain experts.


Unique pathways, followed by only one patient, were generally costlier than the most and less frequent pathways. Earlier study findings are confirmed for mastectomy patients, with more frequent pathways having a lower cost, whereas contradicting and inconclusive results emerged for the partial mastectomy patient groups. Highest variation in pathways was identified for patients receiving chemotherapy.

Practical implications

The common belief – if one follows a standardized patient pathway, then the cost will be lower – should be re-examined based on the actual pathways that occur in reality.


The relationships between patient pathways and patient cost allow more complex insights, beyond the general causal relationship between successfully implementing a “to-be” care pathway and lower cost. This highlights data-driven research’s importance, where actual pathways (as-is) provide more useful information than to-be care pathways.



The authors acknowledge the domain experts’ invaluable contribution (data expert, nurse and physicians) at the Region Västra Götaland, Per Sjöli, Roger Olofsson Bagge, Carin Wångblad, Per Nyman and Pernilla Fagerlind, to name a few; and the financial support from Regional Cancer Centre West through the Centre for Healthcare Improvement (CHI) at Chalmers University of Technology.


Dahlin, S. and Raharjo, H. (2019), "Relationship between patient costs and patient pathways", International Journal of Health Care Quality Assurance, Vol. 32 No. 1, pp. 246-261.



Emerald Publishing Limited

Copyright © 2019, Emerald Publishing Limited