DEFINING VALUE IN ORTHOPEDICS: A COMPREHENSIVE REVIEW AND FRAMEWORK FOR DEVELOPING QUALITY AND COST METRICS
Author(s)
Abhinav Balu, BS1, Rithvik Balu, BS2, Philip Louie, MD3;
1Northwestern University, Evanston, IL, USA, 2Rush University Medical Center, Evanston, IL, USA, 3Virginia Mason Medical Center, Seattle, WA, USA
1Northwestern University, Evanston, IL, USA, 2Rush University Medical Center, Evanston, IL, USA, 3Virginia Mason Medical Center, Seattle, WA, USA
OBJECTIVES: The rising cost of orthopedic care has intensified the need for standardized methods to measure value, defined as the relationship between quality and cost. Although the equation Value = Quality / Cost is frequently cited, its use in orthopedic surgery remains inconsistent, and no widely accepted framework guides its application. Existing indices, often developed around specific technologies or payment models, differ in structure, metrics, and alignment with stakeholder priorities. This study reviews existing value indices in orthopedic surgery, synthesizes reported quality and cost metrics, and identifies gaps that must be addressed to create more robust and generalizable value assessment tools.
METHODS: A structured literature review was performed in April 2024 using PubMed, Google Scholar, and Embase to identify published methods for quantifying value in orthopedic surgery. Search terms included value-based care, surgical innovation, time-driven activity-based costing (TDABC), healthcare cost analysis, quality metrics, procedure value index, operative value index, risk adjustment, surgical economics, and outcome measurement. Studies were grouped into quality and cost domains, emphasizing disease-specific outcomes, patient-reported measures, and cost-accounting frameworks such as TDABC.
RESULTS: Between 2015 and 2025, four value indices were identified across shoulder arthroplasty, hip and knee arthroplasty, and spine surgery: the Procedure Value Index (PVI), Operative Value Index (OVI), surgeon scorecards, and TDABC-based models. The PVI defined value as the proportion of patients achieving the minimum clinically important difference per dollar spent. The OVI measured quality-adjusted life years gained per $1,000 of cost. Surgeon scorecards quantified provider-level value using composite metrics across outcomes, experience, and efficiency. TDABC-based models mapped resource use across the surgical episode to estimate cost.
CONCLUSIONS: Existing indices provide a foundation but no consensus on how to measure value in orthopedic care. There is a need for procedure-specific value indices that integrate risk-adjusted outcomes, granular cost data, and surgical appropriateness to enable meaningful value assessment.
METHODS: A structured literature review was performed in April 2024 using PubMed, Google Scholar, and Embase to identify published methods for quantifying value in orthopedic surgery. Search terms included value-based care, surgical innovation, time-driven activity-based costing (TDABC), healthcare cost analysis, quality metrics, procedure value index, operative value index, risk adjustment, surgical economics, and outcome measurement. Studies were grouped into quality and cost domains, emphasizing disease-specific outcomes, patient-reported measures, and cost-accounting frameworks such as TDABC.
RESULTS: Between 2015 and 2025, four value indices were identified across shoulder arthroplasty, hip and knee arthroplasty, and spine surgery: the Procedure Value Index (PVI), Operative Value Index (OVI), surgeon scorecards, and TDABC-based models. The PVI defined value as the proportion of patients achieving the minimum clinically important difference per dollar spent. The OVI measured quality-adjusted life years gained per $1,000 of cost. Surgeon scorecards quantified provider-level value using composite metrics across outcomes, experience, and efficiency. TDABC-based models mapped resource use across the surgical episode to estimate cost.
CONCLUSIONS: Existing indices provide a foundation but no consensus on how to measure value in orthopedic care. There is a need for procedure-specific value indices that integrate risk-adjusted outcomes, granular cost data, and surgical appropriateness to enable meaningful value assessment.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
EE130
Topic
Economic Evaluation
Topic Subcategory
Value of Information
Disease
SDC: Musculoskeletal Disorders (Arthritis, Bone Disorders, Osteoporosis, Other Musculoskeletal), STA: Surgery