Value-based health care in breast cancer care
13 Apr 2017

This is a summary of the pilot study regarding the development of a value-based monitoring platform for breast cancer care in Sweden.

Initial analysis of data

To understand the relevant outcomes, historical data from 2009-2010 on more than 6 000 breast cancer patients were analyzed. The analyses covered the period from 2 years before diagnose to 5 years after diagnose, and the data was obtained from the participating county councils’ patient registries and national quality registries. The results were adjusted for patient case mix at the respective healthcare provider and county council to enable comparability.

Value-based health care model

Based on the analysis of the historical cohort and the expert working group the following parameters where included in the VBHC model:

Health outcomes

  • Proportion of disease-free survival, 2 years
  • Proportion of survived patients, 5 years
  • Proportion without distant metastases after primary diagnosis, 2 years
  • Proportion without re-operation due to complication, 6 weeks
  • Incidence of heart failure during year 2
  • Postoperative infection, 1 year

Resource use

  • Proportion with surgery
  • Proportion of breast-conserving surgeries
  • Total number of inpatient days, 1 year
  • Number of outpatient visits in specialist care, 1 year
  • Number of visits in primary care, 1 year

The analysis showed large variations and significant differences in the health outcomes and resource use within breast cancer care in the county councils. Adjustment for patient case mix had an impact on the results.

Recommended actions

Based on the analysis, Sveus’ expert group in breast cancer recommended the establishment of a value-based monitoring platform to enable new and important follow-up of breast cancer care. In the platform, resource and performance measures can be compared between healthcare providers.

For more information (in Swedish only):

Sveus is an ongoing research and development project aimed at developing models for value-based health care (VBHC) in several disease areas in Sweden. Seven county councils and regions participate in the work, with support from the Ministry of Social Affairs, including involvement of more than 50 organizations.