Defining the value of spine care.

The increased cost and frequency of spine-related procedures, expanding indications, and regional variation in care has led to a shift toward delivery of value-based spine care. In this model, payers show preference for interventions and treatments with proven value and incentivize providers who use such interventions and demonstrate value in their practices. Thus, spine care providers must understand how to determine the value of interventions and treatments. Determining value (ie, cost and quality of care, measured over time) can be challenging in the setting of spine care. Data collection and reporting are complicated by variation in diagnostic coding and surgical techniques. Typically, outcomes in spine care are based on subjective patient-reported measures that are influenced by concomitant orthopaedic, medical, and psychological disease. Health utility is a preferable measure of quality that can be converted into quality-adjusted life years and used in cost-effectiveness analysis. Although no standard currently exists, estimates of cost should include both direct and indirect costs of care over an adequate time horizon.