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• W3110638235 abstract "Commentary Economic analyses are an important instrument to support the transformation to value-based care. Formal, well-executed cost-effectiveness analyses that incorporate both costs and outcomes are considered complete economic analyses. Many countries use these analyses to directly guide policy, whereas in the U.S., there is evidence to suggest that they indirectly guide policy1. Furthermore, as clinicians assume more financial risk and value-based care, we rely on economic analysis to construct our own internal policy and practices. Many clinicians have limited experience with these methodologies, creating challenges for interpretation and application. Thus, a rigorous peer-review process is especially valuable for these studies. A key element of the methodology of an economic analysis is the perspective—that is, which stakeholder’s costs and outcomes does the analysis consider? For example, consideration of reimbursement as the only cost would reflect the perspective of the payer. The Panel on Cost-Effectiveness in Health and Medicine recommends the societal perspective, which considers costs other than the direct costs of treatment, most notably, lost productivity and caregiver costs2. Many economic analyses do not consider these indirect costs and consequently are incomplete. Economic analyses can be done with many different data sources, from previously published studies to internal practice/health system data to claims data. While these sources can be effective, an economic analysis designed prospectively with a randomized clinical trial arguably represents the ideal methodology. Last, another important element is for an economic analysis to address a common clinical problem that consumes substantial health-care resources. Hammer et al., in their study entitled “Cost-Effectiveness of Volar Locking Plate Compared with Augmented External Fixation for Displaced Intra-Articular Wrist Fractures,” addressed each of these key areas by beginning with a common and increasingly prevalent injury, including a detailed assessment of indirect costs and missed work days, and performing their economic analysis alongside a randomized clinical trial. They found few differences between the 2 groups except for recovery-related costs in the external fixation group. The external fixation group had more unplanned visits to the general practitioner, greater utilization of home nursing and physiotherapy, and greater missed workdays. Patients in the locked volar plating group had higher initial costs related to surgical fixation but these were offset substantially by the relatively smaller loss of productivity. There was no difference in quality-adjusted life-years between the groups. The primary weakness of the study lies in the inherent challenges of measuring indirect costs and productivity lost from injuries. The heterogeneity of occupational demands makes measuring lost productivity for a population in a study challenging and introduces error. Likewise, these same factors influence caregiver costs. In addition, the formal loss of productivity could be replaced with other output that is not captured or that is replaced by personnel not previously working, thus neutralizing lost productivity at the societal level. It is important to understand that economic analyses are frameworks to support institutional policy creation and shared decision-making. While formal tools are needed to support and streamline shared decision-making, clinicians can start today by using the results of this study. For example, clinicians can use the results of this study for shared decision-making by including a discussion with the patient and family regarding the effects of surgical treatment options on downstream health-care utilization and productivity. Optimal shared decision-making involves unnecessarily increasing cognitive burden, which is often inadvertently done by discussing treatment details that are not relevant to the decision. Clinicians can use this study to focus conversations with patients to the differences between treatment options. As we continue our transformation to value-based care, this study reminds us that patient-centered value-based care includes getting patients back to work and that productivity-related outcomes can be the primary differentiator between treatment options." @default.
• W3110638235 created "2020-12-07" @default.
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• W3110638235 date "2020-12-02" @default.
• W3110638235 modified "2023-09-25" @default.
• W3110638235 title "Value-Based Care Includes Getting Patients Back to Work" @default.
• W3110638235 cites W1966884056 @default.
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• W3110638235 doi "https://doi.org/10.2106/jbjs.20.01760" @default.
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