OBJECTIVES: To discuss the evolution to value-based care in surgery, describe defects in value in rectal cancer treatment, and suggest approaches to improve value.

METHODS: This review examines defects in value in rectal cancer care and describes opportunities to reverse these defects. Defects in value compromise quality and the patient experience and can increase costs of care. To assess how to improve value for rectal cancer care, we identified rectal cancer care that provided no value (no clinical benefit and may be harmful to the patient with increased costs) and low value (increased cost with little to no clinical benefit or decreased both cost and quality-adjusted life years) and estimated the opportunity costs that could have been saved by eliminating these defects in value in the U.S. healthcare system.

RESULTS: Restricting the utilization of neoadjuvant therapy to only high-risk patients is considered as a potential to improve value, representing an opportunity cost of over $273 million per year. With fewer treated with neoadjuvant therapy, the number of loop ileostomy and the subsequent post-discharge care can be reduced, resulting in $18,001,170 of saving annually. $47 million could been allocated to other resources if catastrophic complications post-surgery such as anastomotic leaks can be reduced from 15% to 10%. Furthermore, we call for consideration of cost-benefit ratio before using expensive technologies (robotics vs. traditional open approach). In addition, having more patients treated in high-volume centers by multidisciplinary teams of rectal cancer specialists and increasing adherence to evidence-based standards of care can improve patient outcomes and reduce the costs by up to $2,512,602 per year.

CONCLUSIONS: Significant opportunities exist to improve the value of rectal cancer care and surgeons have an important role in achieving high-value care that provide high quality outcomes at lower costs with increase in patient satisfaction.