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Related Experiment Video

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Reverse Total Shoulder Arthroplasty
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The procedure value index: a new method for quantifying value in shoulder arthroplasty.

Derek D Berglund1, Tsun Yee Law1, Samuel Rosas2

  • 1Holy Cross Orthopedic Institute, Fort Lauderdale, FL, USA.

Journal of Shoulder and Elbow Surgery
|December 16, 2018
PubMed
Summary

The Procedure Value Index (PVI) quantifies value in shoulder arthroplasty. Total shoulder arthroplasty (TSA) demonstrated a higher PVI than reverse shoulder arthroplasty (RSA) due to lower costs, despite similar clinical outcomes.

Keywords:
Procedure value index (PVI)anatomic total shoulder arthroplasty (TSA)costminimal clinically important difference (MCID)reverse total shoulder arthroplasty (RSA)value

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Area of Science:

  • Orthopedic surgery
  • Health economics
  • Value-based healthcare

Background:

  • The Procedure Value Index (PVI) is a novel instrument for quantifying value-driven care.
  • The PVI utilizes the minimal clinically important difference (MCID) in its value equation.
  • This study applies the PVI to shoulder arthroplasty, comparing primary anatomic total shoulder arthroplasty (TSA) and reverse shoulder arthroplasty (RSA).

Purpose of the Study:

  • Introduce and apply the Procedure Value Index (PVI) to shoulder arthroplasty.
  • Objectively quantify value-driven care using MCID units.
  • Compare the PVI between TSA and RSA to identify value differences.

Main Methods:

  • Retrospective analysis of 534 patients undergoing primary shoulder arthroplasty with ≥2-year follow-up.
  • Determined MCIDs for Simple Shoulder Test (SST), ASES, VAS pain, and SANE scores.
  • Calculated PVI as MCID improvement divided by total hospitalization costs and charges.

Main Results:

  • MCIDs were established for SST (3.61), ASES (29.49), VAS pain (3.28), and SANE (37.05).
  • Clinical outcome improvements (in MCID units) were similar between TSA and RSA, except for ASES.
  • Total hospitalization costs and charges were significantly higher for RSA (P<.001), leading to a significantly greater PVI for TSA (P<.05).

Conclusions:

  • The PVI is significantly greater for TSA compared to RSA when considering total hospitalization costs and charges.
  • The PVI effectively highlights value disparities between different shoulder arthroplasty procedures.
  • This metric aids in understanding and optimizing value-based care in orthopedic surgery.