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de la Plaza Llamas R, Ortega Azor L, Hernández Yuste M, Gorini L, Latorre-Fragua RA, Díaz Candelas DA, Al Shwely Abduljabar F, Gemio del Rey IA. Quality-adjusted life years and surgical waiting list: Systematic review of the literature. World J Gastrointest Surg 2024; 16:1155-1164. [PMID: 38690041 PMCID: PMC11056653 DOI: 10.4240/wjgs.v16.i4.1155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 01/26/2024] [Accepted: 02/25/2024] [Indexed: 04/22/2024] Open
Abstract
BACKGROUND The quality-adjusted life year (QALY) is a metric that is increasingly used today in the field of health economics to evaluate the value of different medical treatments and procedures. Surgical waiting lists (SWLs) represent a pressing problem in public healthcare. The QALY measure has rarely been used in the context of surgery. It would be interesting to know how many QALYs are lost by patients on SWLs. AIM To investigate the relationship between QALYs and SWLs in a systematic review of the scientific literature. METHODS The study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement. An unlimited search was carried out in PubMed, updated on January 19, 2024. Data on the following variables were investigated and analyzed: Specialty, country of study, procedure under study, scale used to measure QALYs, the use of a theoretical or real-life model, objectives of the study and items measured, the economic value assigned to the QALY in the country in question, and the results and conclusions published. RESULTS Forty-eight articles were selected for the study. No data were found regarding QALYs lost on SWLs. The specialties in which QALYs were studied the most in relation to the waiting list were urology and general surgery, with 15 articles each. The country in which the most studies of QALYs were carried out was the United States (n = 21), followed by the United Kingdom (n = 9) and Canada (n = 7). The most studied procedure was organ transplantation (n = 39), including 15 kidney, 14 liver, 5 heart, 4 lung, and 1 intestinal. Arthroplasty (n = 4), cataract surgery (n = 2), bariatric surgery (n = 1), mosaicplasty (n = 1), and septoplasty (n = 1) completed the surgical interventions included. Thirty-nine of the models used were theoretical (the most frequently applied being the Markov model, n = 34), and nine were real-life. The survey used to measure quality of life in 11 articles was the European Quality of Life-5 dimensions, but in 32 articles the survey was not specified. The willingness-to-pay per QALY gained ranged from $100000 in the United States to €20000 in Spain. CONCLUSION The relationship between QALYs and SWLs has only rarely been studied in the literature. The rate of QALYs lost on SWLs has not been determined. Future research is warranted to address this issue.
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Affiliation(s)
- Roberto de la Plaza Llamas
- Department of General and Digestive Surgery, Hospital Universitario de Guadalajara, Guadalajara 19002, Spain
- Department of Surgery, Medical and Social Sciences, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares 28871, Madrid, Spain
| | - Lorena Ortega Azor
- Department of Surgery, Medical and Social Sciences, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares 28871, Madrid, Spain
| | - Marina Hernández Yuste
- Department of Surgery, Medical and Social Sciences, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares 28871, Madrid, Spain
| | - Ludovica Gorini
- Department of General and Digestive Surgery, Hospital Universitario de Guadalajara, Guadalajara 19002, Spain
| | - Raquel Aránzazu Latorre-Fragua
- Department of General and Digestive Surgery, Hospital Universitario de Guadalajara, Guadalajara 19002, Spain
- Department of Surgery, Medical and Social Sciences, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares 28871, Madrid, Spain
| | | | - Farah Al Shwely Abduljabar
- Department of General and Digestive Surgery, Hospital Universitario de Guadalajara, Guadalajara 19002, Spain
- Department of Surgery, Medical and Social Sciences, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares 28871, Madrid, Spain
| | - Ignacio Antonio Gemio del Rey
- Department of General and Digestive Surgery, Hospital Universitario de Guadalajara, Guadalajara 19002, Spain
- Department of Surgery, Medical and Social Sciences, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares 28871, Madrid, Spain
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Cooper GM, Bayram JM, Clement ND. The functional and psychological impact of delayed hip and knee arthroplasty: a systematic review and meta-analysis of 89,996 patients. Sci Rep 2024; 14:8032. [PMID: 38580681 PMCID: PMC10997604 DOI: 10.1038/s41598-024-58050-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 03/25/2024] [Indexed: 04/07/2024] Open
Abstract
This systematic review and meta-analysis aimed to determine the impact of presurgical waiting times on pre-/post-operative joint specific pain and function, health-related quality of life (HRQOL) and perspectives of patients awaiting primary elective total hip (THR) and knee (TKR) replacements. MEDLINE, EMBASE, PUBMED, and CENTRAL databases were searched from inception until 30th January 2023 (CRD42022288128). Secondary literature and unpublished datasets containing paediatric, non-elective, partial, or revision replacement populations were excluded. PRISMA 2020 reporting and GRADE certainty of evidence guidelines were followed. Residual maximum likelihood meta-analysis and linear meta-regression was performed to elucidate the influence of presurgical waiting time. Twenty-six studies were eligible for systematic review and sixteen for meta-analysis, capturing 89,996 patients (60.6% female, mean age 67.4 years) between 2001 and 2022. A significant deterioration in joint function (mean difference (MD):0.0575%; 95% CI 0.0064, 0.1086; p = 0.028(4d.p.); I2 = 73.1%) and HRQOL (MD: 0.05%; 95% CI - 0.0001.0009; p = 0.011(4 d.p.); I2 = 80.6%) was identified per additional day of waiting. Despite qualitative evidence, meta-analysis could not observe a relationship with postoperative outcome data. Patient responses to delayed THR and TKR surgery were unanimously negative. Immediate action should seek to reduce the increased patient anxiety and significant reductions in pre-operative joint functionality and HRQOL associated with prolonged pre-surgical waiting time, whilst mitigating any potential deleterious post-operative effects.
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Affiliation(s)
- G M Cooper
- University of Edinburgh Medical School, 47 Little France Crescent, Edinburgh, EH16 4TJ, UK.
| | - J M Bayram
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SA, UK
| | - N D Clement
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SA, UK
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Oosterhoff M, Kouwenberg LHJA, Rotteveel AH, van Vliet ED, Stadhouders N, de Wit GA, van Giessen A. Estimating the health impact of delayed elective care during the COVID -19 pandemic in the Netherlands. Soc Sci Med 2023; 320:115658. [PMID: 36689820 PMCID: PMC9810553 DOI: 10.1016/j.socscimed.2023.115658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 12/02/2022] [Accepted: 01/03/2023] [Indexed: 01/05/2023]
Abstract
BACKGROUND The COVID-19 pandemic had a major impact on the continuity of healthcare provision. Appointments, treatments and surgeries for non-COVID patients were often delayed, with associated health losses for patients involved. OBJECTIVE To develop a method to quantify the health impact of delayed elective care for non-COVID patients. METHODS A model was developed that estimated the backlog of surgical procedures in 2020 and 2021 using hospital registry data. Quality-adjusted life years (QALYs) were obtained from the literature to estimate the non-generated QALYs related to the backlog. In sensitivity analyses QALY values were varied by type of patient prioritization. Scenario analyses for future increased surgical capacity were performed. RESULTS In 2020 and 2021 an estimated total of 305,374 elective surgeries were delayed. These delays corresponded with 319,483 non-generated QALYs. In sensitivity analyses where QALYs varied by type of patient prioritization, non-generated QALYs amounted to 150,973 and 488,195 QALYs respectively. In scenario analyses for future increased surgical capacity in 2022-2026, the non-generated QALYs decreased to 311,220 (2% future capacity increase per year) and 300,710 (5% future capacity increase per year). Large differences exist in the extent to which different treatments contributed to the total health losses. CONCLUSIONS The method sheds light on the indirect harm related to the COVID-19 pandemic. The results can be used for policy evaluations of COVID-19 responses, in preparations for future waves or other pandemics and in prioritizing the allocation of resources for capacity increases.
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Affiliation(s)
- Marije Oosterhoff
- Centre for Nutrition, Prevention and Healthcare, National Institute of Public Health and the Environment, PO Box 1, 3720 BA, Bilthoven, the Netherlands.
| | - Lisanne H J A Kouwenberg
- Centre for Nutrition, Prevention and Healthcare, National Institute of Public Health and the Environment, PO Box 1, 3720 BA, Bilthoven, the Netherlands; Amsterdam UMC location University of Amsterdam, Public and Occupational Health, Meibergdreef 9, Amsterdam, the Netherlands.
| | - Adriënne H Rotteveel
- Centre for Nutrition, Prevention and Healthcare, National Institute of Public Health and the Environment, PO Box 1, 3720 BA, Bilthoven, the Netherlands.
| | - Ella D van Vliet
- Centre for Health Protection, National Institute of Public Health and the Environment, PO Box 1, 3720 BA, Bilthoven, the Netherlands.
| | - Niek Stadhouders
- Scientific Institute for Quality of Healthcare, Radboud University Medical Center, PO Box 9101m 6500 HB, Nijmegen, the Netherlands.
| | - G Ardine de Wit
- Centre for Nutrition, Prevention and Healthcare, National Institute of Public Health and the Environment, PO Box 1, 3720 BA, Bilthoven, the Netherlands; Vrije Universiteit Amsterdam, Faculty of Science, Department of Health Sciences & Amsterdam Public Health Research Institute, De Boelelaan 1085, 1081 HV, Amsterdam, the Netherlands.
| | - Anoukh van Giessen
- Centre for Nutrition, Prevention and Healthcare, National Institute of Public Health and the Environment, PO Box 1, 3720 BA, Bilthoven, the Netherlands.
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The impact of waiting time for orthopaedic consultation on pain levels in individuals with osteoarthritis: a systematic review and meta-analysis. Osteoarthritis Cartilage 2022; 30:1561-1574. [PMID: 35961505 DOI: 10.1016/j.joca.2022.07.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 06/30/2022] [Accepted: 07/27/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Time spent waiting for access to orthopaedic specialist health services has been suggested to result in increased pain in individuals with osteoarthritis (OA). We assessed whether time spent on an orthopaedic waiting list resulted in a detrimental effect on pain levels in patients with knee or hip OA. METHODS We searched Ovid MEDLINE, EMBASE and EBSCOhost databases from inception until September 2021. Eligible articles included individuals with OA on an orthopaedic waitlist and not receiving active treatment, and reported pain measures at two or more time points. Random-effects meta-analysis was used to estimate the pooled effect of waiting time on pain levels. Meta-regression was used to determine predictors of effect size. RESULTS Thirty-three articles were included (n = 2,490 participants, 67 ± 3 years and 62% female). The range of waiting time was 2 weeks to 2 years (20.8 ± 18.8 weeks). There was no significant change in pain over time (effect size = 0.082, 95% CI = -0.009, 0.172), nor was the length of time associated with longitudinal changes in pain over time (β = 0.004, 95% CI = -0.005, 0.012). Body mass index was a significant predictor of pain (β = -0.043, 95% CI = -0.079, 0.006), whereas age and sex were not. CONCLUSIONS Pain remained stable for up to 1 year in patients with OA on an orthopaedic waitlist. Future research is required to understand whether pain increases in patients waiting longer than 1 year.
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Lim JA, Thahir A. Perioperative management of elderly patients with osteoarthritis requiring total knee arthroplasty. J Perioper Pract 2021; 31:209-214. [PMID: 33745384 PMCID: PMC8167922 DOI: 10.1177/1750458920936940] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Knee osteoarthritis is a common arthritic disease which mainly affects the elderly (≥65 years old) population. As a result of the cartilage degeneration, it can cause a significant amount of pain and functional limitation. In patients who are refractory to conservative management, total knee arthroplasty is being utilised as the last resort in management. In this review, we discuss the perioperative management of elderly patients with osteoarthritis requiring total knee arthroplasty.
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Affiliation(s)
- Jiang An Lim
- Department of Trauma and Orthopeadics, Addenbrookes Major Trauma Unit, Cambridge University Hospitals, Cambridge, UK.,School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Azeem Thahir
- Department of Trauma and Orthopeadics, Addenbrookes Major Trauma Unit, Cambridge University Hospitals, Cambridge, UK
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Cost-Effectiveness of Arthroplasty Management in Hip and Knee Osteoarthritis: a Quality Review of the Literature. CURRENT TREATMENT OPTIONS IN RHEUMATOLOGY 2020. [DOI: 10.1007/s40674-020-00157-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Reichert A, Jacobs R. The impact of waiting time on patient outcomes: Evidence from early intervention in psychosis services in England. HEALTH ECONOMICS 2018; 27:1772-1787. [PMID: 30014544 PMCID: PMC6221005 DOI: 10.1002/hec.3800] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Revised: 05/16/2018] [Accepted: 06/15/2018] [Indexed: 05/25/2023]
Abstract
Recently, new emphasis was put on reducing waiting times in mental health services as there is an ongoing concern that longer waiting time for treatment leads to poorer health outcomes. However, little is known about delays within the mental health service system and its impact on patients. We explore the impact of waiting times on patient outcomes in the context of early intervention in psychosis (EIP) services in England from April 2012 to March 2015. We use the Mental Health Services Data Set and the routine outcome measure the Health of the Nation Outcome Scale. In a generalised linear regression model, we control for baseline outcomes, previous service use, and treatment intensity to account for possible endogeneity in waiting time. We find that longer waiting time is significantly associated with a deterioration in patient outcomes 12 months after acceptance for treatment for patients that are still in EIP care. Effects are strongest for waiting times longer than 3 months, and effect sizes are small to moderate. Patients with shorter treatment periods are not affected. The results suggest that policies should aim to reduce excessively long waits in order to improve outcomes for patients waiting for treatment for psychosis.
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Ribera A, Slof J, Ferreira-González I, Serra V, García-Del Blanco B, Cascant P, Andrea R, Falces C, Gutiérrez E, Del Valle-Fernández R, Morís-de laTassa C, Mota P, Oteo JF, Tornos P, García-Dorado D. The impact of waiting for intervention on costs and effectiveness: the case of transcatheter aortic valve replacement. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2018; 19:945-956. [PMID: 29170843 DOI: 10.1007/s10198-017-0941-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 11/13/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES The economic crisis in Europe might have limited access to some innovative technologies implying an increase of waiting time. The purpose of the study is to evaluate the impact of waiting time on the costs and benefits of transcatheter aortic valve replacement (TAVR) for the treatment of severe aortic stenosis. METHODS This is a cost-utility analysis from the perspective of the Spanish National Health Service. Results of two prospective hospital registries (158 and 273 consecutive patients) were incorporated into a probabilistic Markov model to compare quality adjusted life years (QALYs) and costs for TAVR after waiting for 3-12 months, relative to immediate TAVR. We simulated a cohort of 1000 patients, male, and 80 years old; other patient profiles were assessed in sensitivity analyses. RESULTS As waiting time increased, costs decreased at the expense of lower survival and loss of QALYs, leading to incremental cost-effectiveness ratios for eliminating waiting lists of about 12,500 € per QALY. In subgroup analyses prioritization of patients for whom higher benefit was expected led to a smaller loss of QALYs. Concerning budget impact, long waiting lists reduced spending considerably and permanently. CONCLUSIONS A shorter waiting time is likely to be cost-effective (considering commonly accepted willingness-to-pay thresholds in Europe) relative to 3 months or longer waiting periods. If waiting lists are nevertheless seen as unavoidable due to severe but temporary budgetary restrictions, prioritizing patients for whom higher benefit is expected appears to be a way of postponing spending without utterly sacrificing patients' survival and quality of life.
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Affiliation(s)
- Aida Ribera
- Cardiovascular Clinical Epidemiology Unit, Cardiology Department, University Hospital Vall d'Hebron, Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Pg. Vall d'Hebron, 119-129, 08035, Barcelona, Spain
- Cardiology Department (CIBERCV), University Hospital Vall d'Hebron, Pg. Vall d'Hebron, 119-129, 08035, Barcelona, Spain
| | - John Slof
- Department of Business, Universitat Autònoma de Barcelona, B2, Av. de l'Eix Central, s/n, 08193 Cerdanyola del Vallès, Barcelona, Spain
| | - Ignacio Ferreira-González
- Cardiovascular Clinical Epidemiology Unit, Cardiology Department, University Hospital Vall d'Hebron, Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Pg. Vall d'Hebron, 119-129, 08035, Barcelona, Spain.
- Cardiology Department (CIBERCV), University Hospital Vall d'Hebron, Pg. Vall d'Hebron, 119-129, 08035, Barcelona, Spain.
| | - Vicente Serra
- Cardiology Department (CIBERCV), University Hospital Vall d'Hebron, Pg. Vall d'Hebron, 119-129, 08035, Barcelona, Spain
| | - Bruno García-Del Blanco
- Cardiology Department, Thorax Institute, Hospital Clinic, IDIBAPS, University of Barcelona, Carrer de Villarroel, 170, 08036, Barcelona, Spain
| | - Purificació Cascant
- Cardiovascular Clinical Epidemiology Unit, Cardiology Department, University Hospital Vall d'Hebron, Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Pg. Vall d'Hebron, 119-129, 08035, Barcelona, Spain
| | - Rut Andrea
- Cardiology Department, Thorax Institute, Hospital Clinic, IDIBAPS, University of Barcelona, Carrer de Villarroel, 170, 08036, Barcelona, Spain
| | - Carlos Falces
- Cardiology Department, Thorax Institute, Hospital Clinic, IDIBAPS, University of Barcelona, Carrer de Villarroel, 170, 08036, Barcelona, Spain
| | - Enrique Gutiérrez
- Cardiology Department, Departamento de Medicina, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense, Calle del Dr. Esquerdo, 46, 28007, Madrid, Spain
| | - Raquel Del Valle-Fernández
- Unidad de Hemodinamica y Cardiología Intervencionista, Area del Corazón, Hospital Universitario Central de Asturias, Av. De Roma, 33011, Oviedo, Asturias, Spain
| | - César Morís-de laTassa
- Unidad de Hemodinamica y Cardiología Intervencionista, Area del Corazón, Hospital Universitario Central de Asturias, Av. De Roma, 33011, Oviedo, Asturias, Spain
| | - Pedro Mota
- Servicio de Cardiología, ICICOR, Hospital Clínico Universitario, Av. Ramón y Cajal, 3, 47003, Valladolid, Spain
| | - Juan Francisco Oteo
- Servicio de Cardiología, Hospital Puerta de Hierro, C/Manuel de Falla, 1, Majadahonda, 28222, Madrid, Spain
| | - Pilar Tornos
- Cardiology Department (CIBERCV), University Hospital Vall d'Hebron, Pg. Vall d'Hebron, 119-129, 08035, Barcelona, Spain
| | - David García-Dorado
- Cardiology Department (CIBERCV), University Hospital Vall d'Hebron, Pg. Vall d'Hebron, 119-129, 08035, Barcelona, Spain
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What is the current evidence of the impact on quality of life whilst waiting for management/treatment of orthopaedic/musculoskeletal complaints? A systematic scoping review. Qual Life Res 2018; 27:2227-2242. [PMID: 29611148 DOI: 10.1007/s11136-018-1846-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2018] [Indexed: 12/29/2022]
Abstract
PURPOSE To describe quality of life (QoL) outcome measures that are reported in the literature in patients waiting for outpatient orthopaedic/musculoskeletal specialist care and how waiting impacts on QoL in these terms. METHODS A subset of studies reporting on QoL outcome measures were extracted from literature identified in a recent scoping search of Medline, Embase, Pubmed, NHS Economic Evaluation Database (Prospero registration CRD42016047332). The systematic scoping search examined impacts on patients waiting for orthopaedic specialist care. Two independent reviewers ranked study design using the National Health and Medical Research Council aetiology evidence hierarchy, and appraised study quality using Critical Appraisal Skills Programme tools. QoL measures were mapped against waiting period timepoints. RESULTS The scoping search yielded 142 articles, of which 18 reported on impact on QoL. These studies reported only on patients waiting for hip and/or knee replacement surgery. The most recent study reported on data collected in 2006/7. The Western Ontario and McMaster Universities Arthritis Index and the SF-36 were the most commonly reported QoL measures. QoL was measured at variable timepoints in the waiting period (from a few weeks to greater than 12 months). The impact of waiting on QoL was inconsistent. CONCLUSION The evidence base was over 10 years old, reported only on patients with hip and knee problems, and on limited QoL outcome measures, and with inconsistent findings. A better understanding of the impact on QoL for patients waiting for specialist care could be gained by using standard timepoints in the waiting period, patients with other orthopaedic conditions, comprehensive QoL measures, as well as expectations, choices and perspectives of patients waiting for specialist care.
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COST-UTILITY ANALYSIS OF PRIVATE CONTRACTING TO REDUCE PUBLIC WAITING TIMES FOR JOINT REPLACEMENT SURGERY. Int J Technol Assess Health Care 2018; 34:147-155. [PMID: 29455686 DOI: 10.1017/s0266462317004524] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES Earlier treatment of publicly funded patients may achieve health gains that justify the additional costs of reducing waiting times. This study reports on the cost-effectiveness of implementing a private contracting model to meet alternative maximum waiting time targets for publicly funded patients undergoing total knee replacement surgery in Australia. METHODS A linked decision tree and cohort Markov model was developed and populated and validated using secondary data sources to represent the pathways, costs, and quality adjusted life-years (QALYs) gained of non-urgent patients with alternative waiting times for total knee replacement surgery to a maximum age of 100 years. RESULTS Assuming public waiting times are reduced through the purchase of private services, additional QALYs are gained at an incremental cost of less than $40,000. Value could be increased if lower private prices could be negotiated. Results are also sensitive to the rate of deterioration in function while waiting for surgery and the impact of functional status at the time of surgery on postsurgery outcomes. CONCLUSIONS More evidence on the value of expanded capacity or new models of care may inform new funding models to support such investments and reduced prices for new technologies, leading to more efficient and sustainable publicly funded healthcare systems.
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Ackerman IN, Bohensky MA, de Steiger R, Brand CA, Eskelinen A, Fenstad AM, Furnes O, Graves SE, Haapakoski J, Mäkelä K, Mehnert F, Nemes S, Overgaard S, Pedersen AB, Garellick G. Lifetime Risk of Primary Total Hip Replacement Surgery for Osteoarthritis From 2003 to 2013: A Multinational Analysis Using National Registry Data. Arthritis Care Res (Hoboken) 2017; 69:1659-1667. [DOI: 10.1002/acr.23197] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 01/17/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Ilana N. Ackerman
- Monash University and University of Melbourne; Melbourne Victoria Australia
| | | | - Richard de Steiger
- Epworth HealthCare and University of Melbourne, Melbourne, Victoria, and Australian Orthopaedic Association National Joint Replacement Registry; Adelaide South Australia Australia
| | | | | | | | - Ove Furnes
- The Norwegian Arthroplasty Register and University of Bergen; Bergen Norway
| | - Stephen E. Graves
- Australian Orthopaedic Association National Joint Replacement Registry; Adelaide South Australia Australia
| | | | - Keijo Mäkelä
- Turku University Hospital, Turku, and Finnish Arthroplasty Register; Helsinki Finland
| | - Frank Mehnert
- Aarhus University Hospital and Danish Hip Arthroplasty Register; Aarhus Denmark
| | - Szilard Nemes
- Swedish Hip Arthroplasty Register; Gothenburg Sweden
| | - Søren Overgaard
- Danish Hip Arthroplasty Register, Aarhus, and Odense University Hospital and University of Southern Denmark; Odense Denmark
| | - Alma B. Pedersen
- Aarhus University Hospital and Danish Hip Arthroplasty Register; Aarhus Denmark
| | - Göran Garellick
- University of Gothenburg and Swedish Hip Arthroplasty Register; Gothenburg Sweden
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Nikolova S, Harrison M, Sutton M. The Impact of Waiting Time on Health Gains from Surgery: Evidence from a National Patient-reported Outcome Dataset. HEALTH ECONOMICS 2016; 25:955-968. [PMID: 26013773 DOI: 10.1002/hec.3195] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2014] [Revised: 03/08/2015] [Accepted: 04/09/2015] [Indexed: 06/04/2023]
Abstract
Reducing waiting times has been a major focus of the English National Health Service for many years, but little is known about the impact on health outcomes. The collection of data on patient-reported outcome measures for all patients undergoing four large-volume procedures facilitates analysis of the impact of waiting times on patient outcomes. The availability of patient-reported outcome measures before and after surgery allows us to estimate the impact of waiting times on the effectiveness of treatment, controlling for pre-surgery health and the endogeneity of waiting times caused by prioritisation with respect to pre-intervention health. We find that waiting time has a negative and statistically significant impact on the health gain from hip and knee replacement surgery and no impact on the effectiveness of varicose vein and hernia surgery. The magnitude of this effect at patient level is small, 0.1% of the outcome measure range for each additional week of waiting. However, the value of this effect is substantially larger than existing estimates of the disutility experienced during the waiting period. The health losses associated with an additional week of waiting for annual populations of hip and knee replacement patients are worth £11.1m and £11.5m, respectively. Copyright © 2015 John Wiley & Sons, Ltd.
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Affiliation(s)
- Silviya Nikolova
- University of Leeds, Academic Unit of Health Economics, Leeds Institute of Health Sciences, Leeds, UK
| | - Mark Harrison
- University of Manchester, Manchester Centre for Health Economics, Institute of Population Health, Manchester, UK
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada
- Centre for Health Evaluation and Outcome Sciences, St Paul's Hospital, Vancouver, BC, Canada
| | - Matt Sutton
- University of Manchester, Manchester Centre for Health Economics, Institute of Population Health, Manchester, UK
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Marques E, Noble S, Blom AW, Hollingworth W. Disclosing total waiting times for joint replacement: evidence from the English NHS using linked HES data. HEALTH ECONOMICS 2014; 23:806-820. [PMID: 23788234 DOI: 10.1002/hec.2954] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2012] [Revised: 04/23/2013] [Accepted: 05/08/2013] [Indexed: 06/02/2023]
Abstract
For the last decade, stringent monitoring of waiting time performance targets provided English hospitals with incentives to reduce official waiting times for elective surgery. It is less clear whether the total amount of time patients waited in secondary care, from first referral to outpatient clinic until treatment, has also fallen. We used Hospital Episode Statistics inpatient data for patients undergoing total joint replacement during a period of active monitoring of targets (between 2006/7 and 2008/9) and linked it to outpatient data to reconstruct patients' pathway in the 3 years before surgery and provide alternative measurements of waiting times. Our findings suggest that although official waiting times decreased drastically in our study period, total waiting time in secondary care has not declined. Patients with shorter official waits spent a longer time in a 'work-up' period prior to inclusion in the official waiting list, and socio-economic inequities persisted in waiting times for joint replacement. We found no evidence that target policies achieved efficiency gains during our study period.
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Affiliation(s)
- Elsa Marques
- School of Social and Community Medicine, University of Bristol, UK
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Effects of Inpatient Rehabilitation in Hip and Knee Osteoarthritis: A Naturalistic Prospective Cohort Study With Intraindividual Control of Effects. Arch Phys Med Rehabil 2013; 94:2139-45. [DOI: 10.1016/j.apmr.2013.03.026] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Revised: 03/07/2013] [Accepted: 03/23/2013] [Indexed: 11/23/2022]
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Mak JCS, Fransen M, Jennings M, March L, Mittal R, Harris IA. Evidence-based review for patients undergoing elective hip and knee replacement. ANZ J Surg 2013; 84:17-24. [PMID: 23496209 DOI: 10.1111/ans.12109] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2013] [Indexed: 12/27/2022]
Abstract
BACKGROUND The objective of this study was to evaluate the evidence for different interventions in the preoperative, perioperative and post-operative care for people undergoing elective total hip (THR) and knee (TKR) replacement surgery. METHOD A multidisciplinary working group comprising consumers, managers and clinicians from the areas of orthopaedics, rheumatology, aged care and rehabilitation evaluated randomized controlled trials (RCTs) and systematic reviews/meta-analyses concerning aspects of preoperative, perioperative and post-operative clinical care periods for THR/TKR through systematic searching of Medline, Embase, CENTRAL and the Cochrane Database of Systematic Reviews from May 2007 to April 2011. Multiple reviewers determined study eligibility and one or more members extracted primary study findings. The body of evidence were assessed and specific recommendations made according to NHMRC guidelines. RESULTS Twenty-five aspects were identified for review. Recommendations for 16 of 25 areas of care were made: impact of waiting, multidisciplinary preparation, preoperative exercise, smoking cessation, interventions for comorbid conditions, predictors of outcome, clinical pathways, implementation of a blood management programme, antibiotic prophylaxis, regional anaesthesia and analgesia, use of a tourniquet in knee replacement, venous thromboembolism prophylaxis, early post-operative cryotherapy, early mobilization and continuous passive motion. In the post-operative period, study heterogeneity across all aspects of care precluded specific recommendations. CONCLUSIONS There was a deficiency in the quality of the evidence supporting key aspects of the continuum of care for primary THR/TKR surgery. Consequently, recommendations were limited. Prioritization and funding for research into areas likely to impact clinical practice and patient outcomes after elective joint replacement surgery are the next important steps.
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Affiliation(s)
- Jenson C S Mak
- Department of Geriatric Medicine, Gosford Hospital, Gosford, New South Wales, Australia; Department of Medicine, Ryde Hospital, Eastwood, New South Wales, Australia
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Cost-utility of waiting time in total joint replacements: a randomized clinical trial. Int J Technol Assess Health Care 2013; 29:27-34. [PMID: 23298468 DOI: 10.1017/s0266462312000657] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
In many Western countries, long waiting times for elective surgery are a concern. Major joint replacement is an example of a type of surgery with a high volume of demand and relatively long waiting periods for patients. As populations get older, the prevalence of slowly progressive diseases, such as osteoarthritis (OA) in hip and knee joints, is increasing. Over three-quarters of a million total hip and knee replacement surgeries are done in the United States annually (1). Furthermore, according to March et al. (1997), the costs of OA have been estimated to account for up to 1–2.5 percent of the Gross National Product (GNP) in several developed countries (2). In Finland, a total of 11,104 total joint replacements (TJRs) were performed in 2004 (hip 6,600 and knee 5,905), with the median waiting time of 181 days for the surgery (hip 153 and knee 209 days). Until 2007, the number of TJRs was 17,334 (hip 7,698 and knee 9,636), with a median waiting time of 120 and 142 days, respectively (3;4). The mean waiting time for elective surgical procedures is approximately 3 months in several countries and the maximum waiting times can stretch into years.
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