Bringing the value equation into play in value-based healthcare

Introduction: 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. Methods: 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. Results: 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. Discussion: 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.