In breast cancer patients, centre B generated additional patient-centred outcome-adjusted life years at lower cost compared to centre A.
Photo by Navy Medicine / Unsplash
Key Takeaway
Note that this proof-of-concept study offers a theoretical framework for benchmarking rather than definitive evidence for clinical decision-making.
This proof-of-concept cohort study included 330 patients diagnosed with breast cancer treated at two healthcare centres. The analysis focused on patient-centred outcome-adjusted life years (PACELYs), costs in euros, incremental value, and value curves. The follow-up period was 12 months. No specific intervention or exposure was reported; instead, the study compared outcomes between the two centres.
The mean PACELYs were observed to be between 69.85 and 73.24. Costs ranged from 12,129 euros to 13,404 euros. Centre B generated an additional PACELY at a cost of 376 euros compared to centre A. No absolute numbers, p-values, or confidence intervals were reported for these results. Safety data, including adverse events, discontinuations, and tolerability, were not reported.
Key limitations include that the value equation remains ambiguous. The study serves more as a theoretical framework than a practical decision-making tool. Funding sources and conflicts of interest were not reported. The study design and data presentation do not support definitive causal conclusions regarding specific treatments.
Despite these limitations, the approach may facilitate comprehensive benchmarking across centres and could be applicable to other medical conditions. Clinicians should recognize this as an early-stage exploration of value metrics rather than established evidence for clinical practice changes.
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View Original Abstract ↓
Value-based healthcare (VBHC) proposes a framework for managing healthcare systems, connecting health and economic outcomes to determine the value of healthcare. The value equation remains ambiguous, serving more as a theoretical framework than a practical decision-making tool. The key challenge lies in estimating and interpreting the value equation. The purpose of this study is to provide a methodological proof-of-concept to address this gap.
A cohort of 330 patients diagnosed with breast cancer with a 12-month follow-up from two healthcare centres was used to illustrate the proposed approach. Patient-reported outcomes and economic-related outcomes (PROs and EROs) were collected. The numerator was defined as the patient-centred outcome-adjusted life years (PACELYs), a novel metric proposed here that combines PROs and survival, whilst the denominator was expressed in euros. Moving towards a marginal perspective, Incremental value (IV) and value curve were proposed as decision-making measures.
The mean PACELYs for healthcare centres A and B were between 69.85 and 73.24, and the costs for these centres were 12,129€–13,404€. The InIV showed that centre B generated an additional PACELY at 376€ compared to A, reflecting differences in organisational efficiency. The value curve showed variation in efficiency across VBHC thresholds, depending on the healthcare context.
This is the first proof-of-concept to estimate a value figure as a patient-centred efficiency measure for comparing healthcare providers within VBHC, with two pivotal transformations of the value equation: the use of PACELYs and the adoption of a marginal perspective, thereby positioning it as a decision-making tool in VBHC. The estimated figure will facilitate comprehensive benchmarking across centres and be applicable to other medical conditions. Further research should focus on designing value-based payment systems.
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