Analysis of value-based healthcare (VBHC) framework by incremental cost-effectiveness of surgical and therapeutic interventions: a retrospective study at tertiary private health group

Abstract

Background: Rising healthcare costs have led to the adoption of value-based healthcare (VBHC), emphasizing patient outcomes and cost efficiency. This study evaluates VBHC in a tertiary private health group, focusing on cost-effectiveness using the median incremental cost-effectiveness ratio (ICER). Methodology: A retrospective cohort study analyzed 1576 patients treated between 2021 and 2024 in Almoosa Health Group, Al-Ahsa, Saudi Arabia. Patients underwent surgeries and therapies for Anterior Cruciate Ligament (ACL) injuries, knee and hip replacements, cerebral palsy, low back pain, and multiple sclerosis (MS). The study applied median ICER methodology to evaluate value-based healthcare by comparing pre-and post-treatment costs with improvements in mobility, pain management, activity levels, self-care, and Functional Independence Measure (FIM) scores. Statistical significance was assessed through non-parametric tests, and analysis was performed in R Studio. Results: Out of a total of 1576 patients, the surgeries included ACL (n = 112, 7.1%), knee replacement (n = 52, 3.3%), cerebral palsy (n = 46, 2.9%), stroke (n = 178,11.2%) hip replacement (n = 12, 0.7%), low back pain (LBP, n = 1124, 71.3%), and multiple sclerosis (MS, n = 52, 3.2%). The study revealed that improvements in mobility (b =–0.469, p = 0.006), pain management (b =–1.175, p = 0.024), and self-care (b =–0.33, p < 0.001) significantly reduced healthcare costs, particularly in TKR and ACL patients. Additionally, ICER values were positively associated with better functional outcomes in MS and stroke patients, with mobility (b = 1.027, p = 0.003) and activity (b = 1.768, p < 0.001). For cerebral palsy, cost change (b = 0.298, p = 0.022) was significantly linked to improved functional independence. Improvements in Mobility, Self-care, pain management, activity, and FIM were all associated with cost savings, with lower ICER values. Conclusion: This study represents one of the earliest investigations of its kind conducted in the Kingdom of Saudi Arabia.VBHC, assessed through median ICER methodology, effectively assessed improved outcomes while reducing costs. Knee and ACL therapies were the most cost-effective, while lower cost-effectiveness in CP and LBP treatments may stem from the chronic nature, variable patient responses, and high resource use. Improving patient selection, standardizing treatment protocols, and enhancing early intervention and care coordination can boost efficiency and outcomes. These findings support VBHC adoption for evidence-based resource allocation specially in KSA region.