Advancing value‐based healthcare in urology to improve outcomes that matter to patients

Healthcare systems across Europe, and around the world, are facing mounting pressure to deliver ever more care within constrained resources. This challenge is driven by – and exacerbated by – rising costs, escalating demand, an ageing population with increasingly complex multimorbidity, growing health inequalities, heightened public expectations, and significant workforce and inflationary pressures 1. In response, the UK Government has recently launched its '10-Year Health Plan', which outlines three strategic shifts – from hospital to community, analogue to digital, and sickness to prevention – to build a health service fit for the future and better aligned with population needs. The Plan includes an explicit focus on value-based approaches. Value-based healthcare (VBHC) is increasingly recognised as a powerful organising concept capable of transforming entire health systems. While its core equation – Value = Outcomes ÷ Cost – suggests a focus on efficiency, VBHC extends far beyond reducing expenditure. In the UK, considerable efforts have been made to apply the theory first proposed by Porter and Teisberg 2, with the aim of achieving more equitable, sustainable, and transparent resource use that delivers better outcomes and experiences for all. This effort is particularly pertinent to urology, where the complexity and chronic nature of many conditions demand a patient-centred approach. In this context, Reitblat et al. 3 conducted a systematic review evaluating the implementation and impact of VBHC in urology. Reorganising care delivery around specific medical conditions was associated with greater adherence to clinical guidelines and improved patient outcomes – especially in prostate cancer, paediatric urology, and the management of LUTS. Evidence from the UK, as well as other health systems such as those in Denmark and Canada, demonstrates that centralising urological cancer care leads to overall enhanced outcomes. Despite these promising developments, few studies have critically assessed the real-world implementation of VBHC within urology. Collective leadership and coordinated action are essential to re-design care systems and unlock the transformative potential of VBHC in practice and at scale. Examples of successful implementation of VBHC include RARP, which has demonstrated cost-effectiveness in both the UK 4 and the USA 5. This is attributed to fewer positive surgical margins and reduced out-of-pocket costs for patients – largely due to faster postoperative recovery and earlier return to work. The National Institute for Health and Care Excellence (NICE) has approved the use and value evaluation of five surgical robots for soft tissue procedures. For robot-assisted surgery to be deemed cost-effective, patients must gain a minimum of 0.1 quality-adjusted life years – equivalent to ~36.5 days of full health. Transforming outpatient centres into integrated 'one-stop' services has posed significant challenges, particularly in South London. Institutions such as Guy's and St Thomas' Hospitals deliver cutting-edge care to a highly diverse patient population – serving both the political elite and some of the most socioeconomically disadvantaged communities. Achieving this level of service integration has required substantial philanthropic funding, meticulous strategic planning, and rigorous evaluation of individual patient outcomes. A 'Mind and Body' approach to prostate cancer care, evaluated through the MIND-P study (ClinicalTrials.gov identifier: NCT04647474) across eight UK centres, highlights the critical importance of addressing mental health alongside physical treatment. Findings reveal that 45% of newly diagnosed patients experience challenges with mental well-being, and 8% report suicidal ideation. These figures underscore that treating prostate cancer in isolation is unlikely to be sufficient. Counselling and psychosocial support should be proactively offered to patients who seek it, ensuring holistic care and improved overall outcomes 6. The ultimate value proposition in healthcare is cancer prevention, as highlighted on the cover of The Lancet in August 2022. A key example lies in tobacco control: could the cessation of smoking in public places lead to a generational decline in the incidence of bladder cancer? Given smoking's strong association with bladder malignancies, this would represent a significant population-level impact – and a powerful demonstration of VBHC in action. Value-based healthcare represents a transformative shift in urological care, prioritising the delivery of high-quality, cost-effective services. By emphasising robust outcome measurement, transparent cost structures, centralised care pathways, and patient-centred approaches, VBHC enhances both clinical effectiveness and patient experience. In this evolving landscape, the BAUS is uniquely positioned to champion these principles – driving innovation, standardisation, and strategic implementation across the UK and internationally. Prokar Dasgupta is supported by the Engineering and Physical Sciences Research Council (EPSRC; grant number EP/Y009800/1), through funding from Responsible AI UK (RAI UK). He also acknowledges funding from the Trustworthy Autonomous Systems (TAS) Hub and UK Research and Innovation (UKRI). He recognises support from the Wellcome Trust for Surgical and Interventional Engineering, the London Institute for Healthcare Engineering (LIHE), the Hinduja-King's Academy, Alberto Recordati, the King's-Vattikuti Institute, The Urology Foundation and King's College London (KCL).