Value-based healthcare analysis of joint replacement surgery for patients with primary hip osteoarthritis

Abstract

BackgroundA quarter of the population present at least once a year with a musculoskeletal disorder. Primary hip osteoarthritis is a high-volume condition with significant clinical need and population-level costs. There remains much variation in patient outcomes and care delivery costs for this condition.AimsThe study aimed to gauge if pathway redesign based on the principles of value-based healthcare (VBHC) could increase value. The aim was to calculate the value of treatment for primary hip osteoarthritis through measuring outcomes that matter to patients, as well as the costs of delivering them. Additionally it aimed to compare two care pathways to identify which elements may better promote the delivery of high-value clinical care.MethodsTwo care models were evaluated: the first being a traditional model with multiple entry points and without pathway standardisation, and the second an intentionally designed standardised multidisciplinary pathway. Mandated National Health Service patient-reported outcomes were assessed but were restructured into a patient-centred format to assess the impact on pain, function and psychological outcomes. Patient-level pathway economic evaluation was performed. Using these data, outcomes were mapped against cost to calculate value.ResultsThere were no significant differences in clinical outcomes between the two models. The intentionally designed model delivered better value care, having lower pathway costs. This model produced a small but inconsistent positive financial margin.ConclusionsIntentionally designed, integrated elective services offer an opportunity to develop and evaluate VBHC models. Analysis of two care pathways from a VBHC perspective demonstrated that an intentionally designed pathway had higher value. The higher value pathway maximised the benefits of having physiotherapists and orthopaedic surgeons working side by side. Developing and measuring patient-orientated outcomes and performing accurate economic evaluation are the key to understanding and achieving better value care.

Implementing a Comprehensive Value-based Healthcare System to Improve Pregnancy and Childbirth Outcomes in Urban and Rural Kenya.

“…VBHC is becoming a trend in transforming health systems in HICs and the rst results of VBHC implementations seem to be positive [28][29][30][31][32]. However, there are methodological and operational challenges to overcome when implementing VBHC in other settings.…”

3D Printing for Hip Implant Applications: A Review

“…In the United Kingdom, the NHS has accepted the value-based healthcare system (VBHC), which has the goal of increasing the obtained values from limited resources that are accessible to the populace [ 9 ]. These values in healthcare can be defined as the result that affects the patients and carers that is related to the cost of providing the results.…”

A standardized framework to evaluate the quality of studies using TDABC in healthcare: the TDABC in Healthcare Consortium Consensus Statement

“…The use of Time-Driven Activity-Based Costing (TDABC) methodology to evaluate costs in healthcare has expanded in the last 5 years, with studies encompassing different healthcare fields such as surgery and perioperative care [1,2], cancer [3], transplants [4,5], outpatient care [6], psychiatry [7], and hospital management [8] as reported in recent systematic reviews [9,10]. The increasing number of TDABC studies suggests that this is an essential method for supporting value-based healthcare management programs [11][12][13]. In fact, in 2020 the Society for Perioperative Assessment and Quality Improvement (SPAQI) outlined eight principles of TDABC and argued that the aforementioned method provides cost transparency to demonstrate value in perioperative care [14].…”