Impact of Value-Based Payment Models on Short-Term Costs and Clinical Outcomes in Surgical Oncology: A Systematic Review

Background: Value-based payment (VBP) models aim to align financial incentives with quality and efficiency of care, yet its impact on surgical oncology, a field defined by clinical complexity and high utilization of resources, remains poorly understood. Therefore, this systematic review aims to synthesize evidence in the field regarding the impact of VBP on costs and short-term surgical outcomes. Methods: We conducted a systematic review following PRISMA guidelines (PROSPERO CRD420261296628). MEDLINE, EMBASE, Web of Science, and CENTRAL were searched from January 2006 through December 2025 for studies containing quantitative data evaluating the impact of VBP models on costs and clinical outcomes in surgical oncology. Two reviewers independently screened, extracted data, and assessed risk of bias using ROBINS-I. Due to substantial conceptual and methodological heterogeneity across VBP models and outcome reporting, a qualitative synthesis was performed. Primary outcomes included short-term expenditures (≤90 days), mortality, complications, readmissions, and length of stay measures. Results: Seven studies reflecting six distinct cohorts were included, predominantly retrospective quasi-experimental analyses using difference-in-difference (DID) approaches. Across studies, participation in VBP models was not associated with statistically significant changes in short-term treatment expenditures, including total costs, index hospitalization costs, readmission-related spending, or skilled nursing facility (SNF) expenditures. Clinical outcomes were likewise largely unaffected: no consistent effect on 30- or 90-day mortality, postoperative complications, readmissions, or length of stay measures were observed. One study reported a modest reduction in 30-day readmissions under a capitation-based model and another study found improved oncological outcomes in a pay-for-performance (P4P) program; however, the latter demonstrated serious risk of bias. Overall, the available evidence did not demonstrate consistent financial or clinical advantages of VBP implementation in surgical oncology. Conclusion: Current evidence does not show consistent short-term financial or clinical benefits of VBP in surgical oncology. However, methodological and conceptual constrains limit definitive conclusions. Oncology-specific payment models and rigorous evaluations incorporating additional long-term, patient-centered outcomes are needed to clarify the role of VBP in cancer surgery.