Abstract
OBJECTIVES: To synthesize conceptual and empirical evidence on value-based procurement (VBP) for medical devices, distinguishing VBP from related constructs (value-based purchasing, value-based contracting), and to identify practical procurement criteria and implementation opportunities for wound care across 14 health systems (United Kingdom, France, Germany, Italy, Portugal, United States, Brazil, South Africa, Australia, China, United Arab Emirates, Saudi Arabia, Poland, and Hungary).
METHODS: Narrative review integrating peer-reviewed literature (MEDLINE/EMBASE) and grey literature (procurement legislation, health technology assessment outputs, policy documents, purchasing-organization materials) published primarily within the last decade. Conceptual synthesis applied established value-based healthcare constructs and the Most Economically Advantageous Tender (MEAT) framework to map procurement award criteria beyond unit price. Wound-care outcome selection was informed by methodological standards for wound reporting and patient-relevant endpoint prioritization to support translation into tender specifications and performance monitoring.
RESULTS: Across jurisdictions, VBP frameworks consistently shift procurement from lowest unit price toward multi-criteria evaluation incorporating clinical outcomes (healing, complications), patient experience, service components, and total cost of care. Legal and institutional enablers for quality-weighted award decisions were identified across systems, with practical guidance operationalizing scoring matrices, market consultation, and performance management. In wound care, resource use drivers, healthcare professional time, visit frequency, complications, hospitalization, dominate total costs; reviewed evidence attributes approximately 80-85% of wound-care expenditure to professional time and hospitalization, with dressing acquisition representing a minority component. Recurrent implementation barriers included heterogeneous endpoints, weak comparative evidence, limited real-world data infrastructure, budget silos, and insufficient procurement capacity to evaluate pathway-level value.
CONCLUSIONS: International experience supports VBP feasibility for wound care when tenders explicitly prioritize patient-relevant outcomes and pathway costs. Strengthening outcome standardization, pragmatic evidence generation, and data infrastructure is essential to scaling VBP and aligning procurement decisions with economic evaluation.
