Modelling Stakeholder Valuation: An Example Using the Surgical Treatments for Gastroesophageal Reflux Disease.

Qizhi V Zheng,Vic Velanovich

doi:10.7759/cureus.19559

Abstract

BackgroundAssessing the value of a treatment is of great importance. Typical methods are directed toward policy decisions. However, individual stakeholders will have different valuation based on their interests.MethodsFormulas were developed to quantify the value of a treatment from the patient, surgeon, hospital, and private third-party payer. These formulas are based on observed factors that go into treatment decision-making for each stakeholder. Using the example of four surgical treatment options for gastroesophageal reflux disease, values for each factor were obtained from publically available documents or were arbitrarily estimated.ResultsFrom the patient perspective, the laparoscopic Nissen fundoplication (LNF) provided the best value at 2.99 quality-adjusted life years per $1,000 spent. From the surgeon perspective, it provided the best value at $752.20 earned per hour effort. From the hospital perspective, LNP provided the best value at $3,446 earned per episode of care. Lastly, from the third-party payer perspective, total incisionless fundoplication provided the best value at $13,336 per year.ConclusionsBecause value is measured differently for each stakeholder, there will be conflicts as to how treatment options are valued.

Highlights

There has been a great deal of attention paid to assessing “value” in health care
The purpose of this study is to model a framework to quantify the factors that may go into treatment decisions by patients, surgeons, hospitals, and private thirdparty payers
We reviewed the literature of costs and outcomes of each of four gastroesophageal reflux disease (GERD) surgeries for each stakeholder|: patient, surgeon, hospital, and private payor

Summary

Introduction

There has been a great deal of attention paid to assessing “value” in health care. These have generally relied on some variation of the following equation: value = quality/cost. The notion here is that the higher quality of care delivered at a lower cost, the higher the value. As cost goes to 0, value will be high as long as quality is some value >0. Prima facie, this is not an acceptable proposition as most patients would not accept very poor quality because it is very cheap. Individual stakeholders will have different valuation based on their interests

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Conclusion