# Comparison of current relative value unit-based prices and utility between common surgical procedures, including orthopedic surgeries, in South Korea

## TL;DR

This study compares surgical procedure prices and patient benefits in South Korea, finding a mismatch between costs and health outcomes.

## Contribution

The study reveals a negative correlation between surgical procedure pricing and patient utility in South Korea, highlighting orthopedic procedures as cost-effective.

## Key findings

- A significant negative correlation (r = −0.558) was found between RVUs and incremental QALY gains across 18 procedures.
- Fatal procedures had higher RVUs but lower QALY gains compared to non-fatal procedures.
- Orthopedic procedures showed higher QALY gains but not higher prices compared to non-orthopedic procedures.

## Abstract

The medical pricing system strongly influences physicians’ job satisfaction and patient health outcomes. This study aimed to investigate the current relative value unit (RVU)-based pricing and utility of patients in commonly performed surgical procedures in South Korea.

Fifteen common surgical procedures were selected from OECD statistics, and three additional orthopedic procedures were examined. The current pricing of each surgical procedure was retrieved from the Korea National Health Insurance Service, and the corresponding utilities were obtained as quality-adjusted life year (QALY) gains from previous studies. The relationship between the current prices (RVUs) and the patients’ utility (incremental QALY gains/year) was analyzed. Subgroup analysis was performed between fatal and non-fatal procedures and between orthopedic and non-orthopedic procedures.

A significant negative correlation (r = − 0.558, p < 0.001) was observed between RVU and incremental QALY among all 18 procedures. The fatal subgroup had a significantly higher RVU than the non-fatal subgroup (p < 0.05), while the former had a significantly lower incremental QALY than the latter (p < 0.001). Orthopedic procedures showed higher incremental QALY values than non-orthopedic procedures, but they did not show higher prices (RVU).

This paradoxical relationship between current prices and patient utility is attributed to the higher pricing of surgical procedures for fatal and urgent conditions. Orthopedic surgery has been found to be a cost-effective treatment strategy. These findings could contribute to a better understanding of the potential role of incremental QALY in pursuing value-based purchasing or reasonable modification of the current medical fee schedule.