Measurement of value in rotator cuff repair: patient-level value analysis for the 1-year episode of care

Wise, Kelsey; Parikh, Harsh R.; Okelana, Bandele; Only, Arthur J.; Reams, Megan; Harrison, Alicia K.; Braman, Jonathan P.; Craig, Edward V.; Cunningham, Brian P.

doi:10.1016/j.jse.2021.07.004

Cited by 10 publications

(20 citation statements)

References 45 publications

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“…The largest group (n=10) of TDABC studies measured costs across care paths within a single provider and for a single diagnosis. 9 10 31 33 38 43 45 46 52 54 Typically, these studies compared costs between a new intervention and the ‘usual’ care, 9 10 31 46 53 54 or between alternative care paths 33 38 43 52 in order to measure cost savings.…”

Section: Resultsmentioning

confidence: 99%

“…Two recent studies 33 49 have conducted patient-level value analyses, comparing patient-reported outcomes with patient-level TDABC costs. Wise et al 33 did so for rotator cuff repair surgery over a period of 1 year, while McCreary et al 49 analysed ankle fractures. Both studies found costs to be unrelated to patient-reported outcome measures, highlighting the need for further research.…”

Section: Resultsmentioning

confidence: 99%

“…Future research should focus on measuring costs for full care paths, and on comparing costs to outcomes as demonstrated in some of the more recently published studies in our review. 33 38 49 …”

Section: Discussionmentioning

confidence: 99%

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Cost measurement in value-based healthcare: a systematic review

et al. 2022

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ObjectiveAlthough value-based healthcare (VBHC) views accurate cost information to be crucial in the pursuit of value, little is known about how the costs of care should be measured. The aim of this review is to identify how costs are currently measured in VBHC, and which cost measurement methods can facilitate VBHC or value-based decision making.DesignTwo reviewers systematically search the PubMed/MEDLINE, Embase, EBSCOhost and Web of Science databases for publications up to 1 January 2022 and follow Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to identify relevant studies for further analysis.Eligibility criteriaStudies should measure the costs of an intervention, treatment or care path and label the study as ‘value based’. An inductive qualitative approach was used to identify studies that adopted management accounting techniques to identify if or how cost information facilitated VBHC by aiding decision-making.ResultsWe identified 1930 studies, of which 215 measured costs in a VBHC setting. Half of these studies measured hospital costs (110, 51.2%) and the rest relied on reimbursement amounts. Sophisticated costing methods that allocate both direct and indirect costs to care paths were seen as able to provide valuable managerial information by facilitating care path adjustments (39), benchmarking (38), the identification of cost drivers (47) and the measurement of total costs or cost savings (26). We found three best practices that were key to success in cost measurement: process mapping (33), expert input (17) and observations (24).ConclusionsCost information can facilitate VBHC. Time-driven activity-based costing (TDABC) is viewed as the best method although its ability to inform decision-making depends on how it is implemented. While costing short, or partial, care paths and surgical episodes produces accurate cost information, it provides only limited decision-making information. Practitioners are advised to focus on costing full care cycles and to consider both direct and indirect costs through TDABC.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Cost measurement in value-based healthcare: a systematic review

et al. 2022

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“…32 But in the otherwise healthy patient, there is an absence of major clinical differences between the variety of fixation modalities, thus, cost and resource availability becomes the forefront of concern. Within the medical community, including orthopaedic surgery, there has been a push to recognize and identify high value care, [33][34][35] which optimizes the patients' outcomes over cost. With respect to syndesmotic fixation, prior cost analyses have exhibited conflicting data between syndesmotic screws and suspensory button fixation.…”

Section: Discussionmentioning

confidence: 99%

Comparison of a Novel Modified All-Suture Construct versus Suspensory Suture-button Fixation in a Syndesmotic Injury Model

Baker

Muriuki

Straszewski

et al. 2023

Journal of Orthopaedic Trauma

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“…Briefly, TDABC calculates the total cost of a care episode, defined as the sum of all direct and indirect costs incurred within the episode, at the patient level using 2 variables: (1) time spent by a personnel resource to perform an activity, and (2) cost per unit time of the resource under a practical capacity assumption 23 . Process maps to identify the personnel and time involved in performing each activity within the episode of care were generated based on observations and stopwatch times of a single observer during 10 ACLR procedures performed by a variety of surgeons 21 , 30 (Fig. 1 ).…”

Section: Methodsmentioning

confidence: 99%

Cost and Cost Driver Analysis of Anterior Cruciate Ligament Reconstruction Using Time-Driven Activity-Based Costing

et al. 2022

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Background: As health care transitions toward value-based care, orthopaedics has started to implement time-driven activity-based costing (TDABC) to understand costs and cost drivers. TDABC has not previously been used to study cost drivers in anterior cruciate ligament reconstruction (ACLR). The purpose of this study was to use TDABC to (1) calculate bone-tendon-bone (BTB) and hamstring ACLR total costs of care and (2) evaluate the impact of graft choice and other factors on ACLR costs. Methods: Data were collected from electronic medical records for primary ACLR from the institutional patient-reported outcome registry between 2009 and 2016 in 1 ambulatory surgery center. Patients receiving allograft, revision ACLR, or concomitant meniscal repair or ligament reconstruction were excluded. The total cost of care was determined using TDABC. Multivariate regression analysis was conducted between ACLR cost and group characteristics. Results: A total of 328 patients were included; 211 (64.3%) received BTB autograft and 117 (35.7%) received hamstring autograft. The mean cost was $2,865.01 ± $263.45 (95% confidence interval: $2,829.26, $2,900.77) for BTB ACLR versus $3,377.44 ± $320.12 ($3,318.82, $3,436.05) for hamstring ACLR (p < 0.001). Operative time was 103.1 ± 25.1 (99.7, 106.5) minutes for BTB ACLR versus 113.1 ± 27.9 (108.0, 118.2) minutes for hamstring ACLR (p = 0.001). The total implant cost was $270.32 ± $97.08 ($257.15, $283.50) for BTB ACLR versus $587.36 ± $108.78 ($567.44, $607.28) for hamstring ACLR (p < 0.001). Hamstring graft (p = 0.006) and suspensory fixation on the femoral side (p = 0.011) were associated with increased costs. Conclusions: The mean cost of care and operative time for BTB autograft ACLR are less than those for hamstring autograft ACLR. Operative time, implant choice, and graft choice were identified as modifiable cost drivers that can empower surgeons to manage primary ACLR costs while maximizing the value of the procedure. Level of Evidence: Economic and Decision Analysis Level IV . See Instructions for Authors for a complete description of levels of evidence.

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Measurement of value in rotator cuff repair: patient-level value analysis for the 1-year episode of care

Cited by 10 publications

References 45 publications

Cost measurement in value-based healthcare: a systematic review

Cost measurement in value-based healthcare: a systematic review

Comparison of a Novel Modified All-Suture Construct versus Suspensory Suture-button Fixation in a Syndesmotic Injury Model

Cost and Cost Driver Analysis of Anterior Cruciate Ligament Reconstruction Using Time-Driven Activity-Based Costing

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