**1. Introduction**

In the past decades, healthcare challenges have considerably increased due to the global aging of the population and higher treatment costs following advances in medical technologies and medicinal products. In such a context, healthcare actors first focused their interests on reducing costs while giving fewer priorities to patient care quality and efficiency. Therefore, a new disruptive concept emerged to move the current system toward a sustainable and patient-centered model that optimizes both health outcomes and associated costs: the value-based health care (VBHC).

In their work published in 2006, Michael Porter and Elizabeth Teisberg defined value as health outcomes achieved per dollar spent [1]. While this value equation is becoming increasingly prominent, it remains nonetheless difficult to implement in every day clinical practice in absence of a validated method to quantify value and a standard scale for interpretation and benchmarking purposes. In their published article, Reilly et al. [2]

**Citation:** Lädermann, A.; Eurin, R.; Alibert, A.; Bensouda, M.; Bothorel, H. Measuring Patient Value after Total Shoulder Arthroplasty. *J. Clin. Med.* **2021**, *10*, 5700. https://doi.org/ 10.3390/jcm10235700

Academic Editor: Johannes C. Reichert

Received: 18 October 2021 Accepted: 1 December 2021 Published: 4 December 2021

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**Copyright:** © 2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https:// creativecommons.org/licenses/by/ 4.0/).

proposed an innovative method that allows a surgeon to evaluate the value delivered to his patients after total knee or hip arthroplasties according to the average department results. While we applaud them for this work, the applied methodology relies on the presence of several surgeons for establishing the reference. Moreover, the condition mentioned above can be misleading since it can lead to "false positive" or "false negative" results for a particular surgeon if the entire orthopedic department has low or high outcomes.

With the increasing use of patient-reported outcome measures (PROMs), different thresholds have been published to help understand the amount of PROMs improvement that is clinically relevant to patients [3]. Moreover, the standard direct cost for a specific surgical procedure can be estimated from the national hospital reimbursement system based on diagnosis-related groups (DRG). Therefore, the purpose of the present study was to propose a new calculation method to evaluate the delivered patient value using standard references, thereby shifting the value-based competition from a local orthopedic department to a broader level.

#### **2. Materials and Methods**
