Narrative ReviewCost-effectiveness Applications of Patient-reported Outcome Measures (PROMs) in Spine SurgeryLee, Thomas J. MS*; Thomas, Alexander A. BA*; Grandhi, Nikhil R. BS*; Galetta, Matthew S. BA†; Goyal, Dhruv K.C. BA†; Fang, Taolin MD†; Schroeder, Gregory D. MD†; Kepler, Christopher K. MD, MBA†; Vaccaro, Alexander R. MD, PhD, MBA†Author Information *Sidney Kimmel Medical College †Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA Dr Schroeder has received funds to travel from AO Spine and Medtronic. Dr Vaccaro has consulted or has done independent contracting for DePuy, Medtronic, Stryker Spine, Globus, Stout Medical, Gerson Lehrman Group, Guidepoint Global, Medacorp, Innovative Surgical Design, Orthobullets, Ellipse, and Vertex. He has also served on the scientific advisory board/board of directors/committees for Flagship Surgical, AO Spine, Innovative Surgical Design, and Association of Collaborative Spine Research. Dr Vaccaro has received royalty payments from Medtronic, Stryker Spine, Globus, Aesculap, Thieme, Jaypee, Elsevier, and Taylor Francis/Hodder and Stoughton. He has stock/stock option ownership interests in Replication Medica, Globus, Paradigm Spine, Stout Medical, Progressive Spinal Technologies, Advanced Spinal Intellectual Properties, Spine Medica, Computational Biodynamics, Spinology, In Vivo, Flagship Surgical, Cytonics, Bonovo Orthopaedics, Electrocore, Gamma Spine, Location Based Intelligence, FlowPharma, R.S.I., Rothman Institute and Related Properties, Innovative Surgical Design, and Avaz Surgical. He has also served as deputy editor/editor of Spine. In addition, Dr Vaccaro has also provided expert testimony. The other authors declare no conflict of interest. Reprints: Alexander R. Vaccaro, MD, PhD, MBA, 925 Chestnut Street 5th floor, Philadelphia, PA 19107 (e-mail: email@example.com). Received October 10, 2018 Accepted February 17, 2020 Online date: April 7, 2020 Clinical Spine Surgery: May 2020 - Volume 33 - Issue 4 - p 140-145 doi: 10.1097/BSD.0000000000000982 Buy Metrics Abstract Because of the rising health care costs in the United States, there has been a focus on value-based care and improving the cost-effectiveness of surgical procedures. Patient-reported outcome measures (PROMs) can not only give physicians and health care providers immediate feedback on the well-being of the patients but also be used to assess health and determine outcomes for surgical research purposes. Recently, PROMs have become a prominent tool to assess the cost-effectiveness of spine surgery by calculating the improvement in quality-adjusted life years (QALY). The cost of a procedure per QALY gained is an essential metric to determine cost-effectiveness in universal health care systems. Common patient-reported outcome questionnaires to calculate QALY include the EuroQol-5 dimensions, the SF-36, and the SF-12. On the basis of the health-related quality of life outcomes, the cost-effectiveness of various spine surgeries can be determined, such as cervical fusions, lumbar fusions, microdiscectomies. As the United States attempts to reduce costs and emphasize value-based care, PROMs may serve a critical role in spine surgery moving forward. In addition, PROM-driven QALYs may be used to analyze novel spine surgical techniques for value-based improvements. © 2020 by Lippincott Williams & Wilkins, Inc.