title: Setting the equation: establishing value in spine care.
abstract: METHODS
  Topic review.
  
  
  OBJECTIVE
  Describe value measurement in spine care and discuss the motivation for, methods for, and limitations of such measurement.
  
  
  BACKGROUND
  Spinal disorders are common and are an important cause of pain and disability. Numerous complementary and competing treatment strategies are used to treat spinal disorders, and the costs of these treatments is substantial and continue to rise despite clear evidence of improved health status as a result of these expenditures.
  
  
  METHODS
  The authors present the economic and legislative imperatives forcing the assessment of value in spine care. The definition of value in health care and methods to measure value specifically in spine care are presented. Limitations to the utility of value judgments and caveats to their use are presented.
  
  
  RESULTS
  Examples of value calculations in spine care are presented and critiqued. Methods to improve and broaden the measurement of value across spine care are suggested, and the role of prospective registries in measuring value is discussed.
  
  
  CONCLUSIONS
  Value can be measured in spine care through the use of appropriate economic measures and patient-reported outcomes measures. Value must be interpreted in light of the perspective of the assessor, the duration of the assessment period, the degree of appropriate risk stratification, and the relative value of treatment alternatives.
authors.affiliation: *Department of Neurological Surgery, University of Wisconsin School of Medicine and Public Health, K4/834 Clinical Science Center, Madison, WI †Multidisciplinary Clinical Research Center in Musculoskeletal Diseases, The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH ‡Clinical Affairs and Quality Improvement, Hart Health Strategies, Washington, DC §Department of Neurosurgery, Tufts University School of Medicine, Boston, MA; and ¶Lahey Comparative Effectiveness Research Institute, Lahey Hospital and Medical Center, Burlington, MA.
authors.forename: Daniel K
authors.initials: DK
authors.lastname: Resnick
authors.forename: Anna N A
authors.initials: AN
authors.lastname: Tosteson
authors.forename: Rachel F
authors.initials: RF
authors.lastname: Groman
authors.forename: Zoher
authors.initials: Z
authors.lastname: Ghogawala
mesh_terms: D003362:Cost-Benefit Analysis; D003657:Decision Making; D017048:Health Care Costs / Q000331:legislation & jurisprudence; D018166:Health Care Reform; D006801:Humans; D057240:Patient Preference; D058991:Patient Protection and Affordable Care Act; D011787:Quality of Health Care / Q000191:economics*; D019057:Quality-Adjusted Life Years; D013118:Spinal Cord Diseases / Q000191:economics* / Q000628:therapy; D013122:Spinal Diseases / Q000191:economics* / Q000628:therapy; D014481:United States