MEASURING VALUE IN SURGERY: A SYSTEMATIC REVIEW OF ECONOMIC INDICES ACROSS SPECIALTIES
Author(s)
Kenneth Nguyen, BS1, Emaad Lala, BS2, Kento Yamanouchi, MD3, Sydney Pattison, BS2, Aiyush Bansal, MASc, MD4, Abhinav Balu, BS5, Mir Amaan Ali, MD6, Philip Louie, MD4;
1Tulane Medical School, New Orleans, LA, USA, 2University of Washington, Seattle, WA, USA, 3Keio University, Tokyo, Japan, 4Virginia Mason Medical Center, SEATTLE, WA, USA, 5Northwestern University, Evanston, IL, USA, 6Vanderbilt University Medical Center, Nashville, TN, USA
1Tulane Medical School, New Orleans, LA, USA, 2University of Washington, Seattle, WA, USA, 3Keio University, Tokyo, Japan, 4Virginia Mason Medical Center, SEATTLE, WA, USA, 5Northwestern University, Evanston, IL, USA, 6Vanderbilt University Medical Center, Nashville, TN, USA
OBJECTIVES: Although value-based care is increasingly prioritized, surgical value measurement lacks standardization, limiting comparability, reproducibility, and cross-specialty application. This review aims to: (1) characterize trends in value index utilization, (2) examine variability in index components, (3) identify specialty-specific and bibliometric patterns, and (4) propose a practical framework to guide standardized value assessment in surgery.
METHODS: A PRISMA-guided review of PubMed, Embase, and Google Scholar (July 2025) identified 2015-2025 studies evaluating surgical value using “surgery,” “value-based care,” “cost-effectiveness,” and “value index.” Eligible English-language, peer-reviewed studies applied quantitative value indices, while reviews, case reports, and nonoperative studies were excluded. Two reviewers screened independently, and data on specialty, index type, and components were extracted. Bibliometric analysis with CiteSpace mapped keyword clusters and citation trends.
RESULTS: A total of 342 studies met inclusion criteria, identifying 11 indices used to measure surgical value. The most frequent were the Incremental Cost-Effectiveness Ratio (ICER, 55.3%), Time-Driven Activity-Based Costing (TDABC, 27.2%), and Net Monetary Benefit (NMB, 7.9%). Less common measures included Return on Investment (ROI, 6.7%), Operative Value Index (OVI, 1.8%), and rare indices such as Net Health Benefit (NHB), Net Present Value (NPV), and Procedure Value Index (PVI), each under 1%. General, orthopedic, and cardiothoracic surgery were the most represented specialties. Bibliometric analysis revealed orthopedic-related keywords (arthroplasty, spine) and citation bursts in “replacement” and “quality of life.”
CONCLUSIONS: This first comprehensive analysis of surgical value metrics exposes pervasive heterogeneity and introduces a conceptual framework to advance comparable, evidence-based value assessment.
METHODS: A PRISMA-guided review of PubMed, Embase, and Google Scholar (July 2025) identified 2015-2025 studies evaluating surgical value using “surgery,” “value-based care,” “cost-effectiveness,” and “value index.” Eligible English-language, peer-reviewed studies applied quantitative value indices, while reviews, case reports, and nonoperative studies were excluded. Two reviewers screened independently, and data on specialty, index type, and components were extracted. Bibliometric analysis with CiteSpace mapped keyword clusters and citation trends.
RESULTS: A total of 342 studies met inclusion criteria, identifying 11 indices used to measure surgical value. The most frequent were the Incremental Cost-Effectiveness Ratio (ICER, 55.3%), Time-Driven Activity-Based Costing (TDABC, 27.2%), and Net Monetary Benefit (NMB, 7.9%). Less common measures included Return on Investment (ROI, 6.7%), Operative Value Index (OVI, 1.8%), and rare indices such as Net Health Benefit (NHB), Net Present Value (NPV), and Procedure Value Index (PVI), each under 1%. General, orthopedic, and cardiothoracic surgery were the most represented specialties. Bibliometric analysis revealed orthopedic-related keywords (arthroplasty, spine) and citation bursts in “replacement” and “quality of life.”
CONCLUSIONS: This first comprehensive analysis of surgical value metrics exposes pervasive heterogeneity and introduces a conceptual framework to advance comparable, evidence-based value assessment.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
EE398
Topic
Economic Evaluation
Topic Subcategory
Value of Information
Disease
SDC: Musculoskeletal Disorders (Arthritis, Bone Disorders, Osteoporosis, Other Musculoskeletal), STA: Surgery