Value based healthcare estimation values for benchmarking among Spanish Hospitals for four health problems

Describe a methodological proposal and value-based ratio calculations based in real-world hospital-care episodes in Spain, serving as cost per outcomes benchmarking references.

Patient Reported Experience/Outcome Measures (PREMs/PROMs) as well as professional opinions were collected. A first data collection took place (January/June-2023), six months after knee (KP) and hip prostheses (HP) surgeries, as well as after heart failure admissions (HF). A second (February/April-2024) six months after an oncological prostatectomy (OPr) surgeries. Total: 42 hospitals. Costs data was calculated considering patients' episode profiles with Machine-Learning and the Spanish Net of Hospital Costs database, based on a large database of hospital per-episode costs and partial-cost vectors. Crude PROMs scorings were compared across centers. Costs were divided by questionnaire values for reference benchmark ratios.

Full-questionnaire ratios were based on 804 patients (KP), 729 (HP), 717 (set-HF) and 388 (OPr). Cost-per-Value-Based-Units were: 101€/VbU big public-84 medium public-89 private (KP), 110€/VbU-97-86 (HP), 102€/VU-46-59 (set-HF) and 68€/VU-56-62 (OPr). The higher variability (HF) was not associated to outcomes but differential costs. Better results were seen in private centers; big public centers treated higher complexity.

The current methodological proposal applied for calculating value-based results calculated in a large number of centers in Spain is feasible to calculate and therefore be used to evaluate for the improvement of variability in results according to health expenditure in different pathologies and types of centers.