The impact of waiting time on health gains from surgery: Evidence from a national patient reported outcomes dataset Running title
Yüklə 116,56 Kb.
|
- Bu səhifədəki naviqasiya:
- 5Discussion
4.3Value of the health lossesBased on the estimated life expectancy of patients, we estimate the value of reducing waiting times by a week to be approximately £153 per hip replacement patient and £149 per knee replacement patient. The volume of PROMs-eligible procedures in 2011/12 was 72,338 hip replacements and 77,441 knee replacements (Health and Social Care Information Centre, 2013). Using these volumes, we estimate that the value of the health losses associated with an increase in average waiting times of one week would be £11.1million for hip replacements and £11.5million for knee replacements. 5DiscussionThe availability of pre- and post-surgery outcomes in the national PROMs dataset provides a rare opportunity to estimate the value of the health-related quality of life losses associated with waiting for elective surgery. Previous estimates have only captured the value of the disutility of time spent on a waiting list. Our contribution is to estimate the effect of the length of time that a patient waits between the specialist’s decision to treat and the receipt of treatment on the reduction in health gain from surgery using a wide range of health measures for four large volume elective procedures. Our findings indicate that longer inpatient waiting times have a negative and statistically significant effect on all of the post-surgery outcomes for hip and knee replacement patients. We do not find any evidence of impact on health outcomes for varicose veins and inguinal hernia surgery. The results also show a decline in patient satisfaction from hip, knee, and varicose vein surgery and in reported success of surgery for hip replacement and varicose veins. The magnitude of the effects on health outcomes for hip and knee replacement surgery at patient level appears small, at most 0.1% of the outcome measure range for each additional week of waiting. However, the value of the loss in health-related quality of life for each additional week of inpatient waiting equals £153 per hip replacement patient and £149 per knee replacement patient. These estimates are substantially larger than Propper’s (1995) estimates of the disutility of time spent on a waiting list, equivalent to £19 per week at 2013 prices. The value of the poorer long-term health outcomes associated with waiting for treatment therefore seem more important than the discomfort and delay experienced while waiting for treatment, even in a setting with maximum waiting time targets of 18 weeks. A potential limitation of our analysis is that we focus on a limited set of procedures (hip replacement, knee replacement, varicose veins, and hernia repair). Future research would benefit from considering a wider range of interventions. We have also focused only on the length of time that patients wait between the specialist’s decision to offer treatment and the patient’s receipt of treatment, ‘the inpatient wait’. Future work could extend this analysis to include the delay between referral by a general practitioner and the date of the specialist’s decision as this is the focus of current English policy. We have restricted our sample to patients who have completed both the pre- and post-surgery questionnaires. However, missing data on PROMs are of concern as inferences based on individuals with complete information could be misleading (Gomes, et al., 2015)Provider failure to administer the pre-operative questionnaire could potentially bias provider comparisons, but the effect of these differences would be captured by inclusion of provider fixed-effects in our analysis. Nonetheless, within-provider correlation between missing data, waiting times and outcomes could lead to biased estimates. While we document a consistent decline in the health status of hip and knee patients as a result of waiting, we do not know what causes the change. The availability of PROMs prior to surgery does, however, allow us to control for the deterioration in health pre-surgery and endogeneity of waiting times caused by prioritisation based on pre-surgery health. However, the PROMs data collection initiative includes only one follow-up. This might not capture the full impact of waiting for treatment as individuals may recover at different rates and/or the health outcomes measured in the post-surgery questionnaire may be different from the outcomes experienced later on. Our estimate of the decline in health-related quality of life due to an additional week of waiting is a new contribution to the literature which can be used as an indication of the value of the recent deterioration in NHS performance with respect to waiting times for elective treatment. Average waiting times reduced considerably from 42 weeks in 1999/00 to 12 weeks in 2009/10 for hip replacement and from 39 weeks to 13 weeks for knee replacement. If people today were waiting the same length of time as in 1999/00, the value of the associated health-related quality of life losses would be £635 million (£330 million for hip replacement). Since 2009/10 average waiting times for both hip and knee replacements have increased by one week, which is equivalent to a population health-related quality of life loss valued at £11.1 million for hip replacement patients and £11.5 million for knee replacement patients. The recent deterioration in NHS waiting times performance has a substantial health impact at population level, particularly if this reduction in health-related quality of life is sustained over time.
Department of Health, 2008. Guidance on the Routine Collection of Patient t Reported Outcome Measures (PROMs). [Online] Available at: http://www.mstrust.org.uk/competencies/downloads/NHS-PROMS.pdf [Accessed 5 November 2013]. Anon., n.d. Borowitz, M., Moran, V. & Sicliani, L., 2013. Waiting times for health care: a conceptual framework. Chapter 1. In: Waiting times policies in the health sector: what works? OECD Health Policy Studies. s.l.:OECD Publishing. Cullis, J. G., Jones, P. R. & Propper, C., 2000. Waiting lists and medical treatment: analysis and policies. In: J. Culyer & J. P. Newhouse, eds. Handbook of Health Economics, 1 edn, vol. 1 A.. Oxford: North Holland, pp. 1201-1249. Dolan, P., 1997. Modeling valuations for EuroQol health states. Medical Care, 35(11), pp. 1095-108. Escobar, A. et al., 2009. Waiting list management: priority criteria or first-in first-out? A case for total joint replacement. Journal of Evaluation in Clinical Practice, 15(4), pp. 595-601. Garbuz, D. S. et al., 2006. Delays worsen quality of life outcome of primary total hip arthroplasty. Clinical Orthopaedics and Related Research, Volume 447, pp. 79-84. Gomes, M., Gutacker, N., Bojke, C. & Street, A., 2015. Addressing missing data in patient-reported outcome measures (PROMs): implications for the use of PROMs for comparing provider performance. Health Economics(Forthcoming). Hajat, S. et al., 2002. Does waiting for total hip replacement matter? Prospective cohort study. Journal of Health Services Research and Policy, 7(1), pp. 19-25. Health and Social Care Information Centre, 2013. Provisional Monthly Patient Reported Outcome Measures (PROMs) in England - April 2011 to March 2012, Pre- and post-operative data, s.l.: http://www.hscic.gov.uk/searchcatalogue?productid=11551&q=title%3a%22Provisional+Monthly+Patient%22&sort=Most+recent&size=10&page=2#top. Hirvonen, J. et al., 2007. The effect of waiting time on health-related quality of life, pain, and physical function in patients awa. Health Quality of Life Outcomes, 5(16). Hurst, N. P. et al., 2000. Does waiting matter? A randomized controlled trial of new non-urgent rheumatology out-patient referrals. Rheumatology, 39(4), pp. 369-376. Koopmanschap, M. A., Brouwer, W. B. F., Hakkaart-Van Roijen, L. & van Exel, N. J. A., 2005. Influence of waiting time on cost-effectiveness. Social Science and Medicine, 60(11), pp. 2501-2504. Laudicella, M., Siciliani, L. & Cookson, R., 2012. Waiting times and socio-economic status: evidence from England. Social Science and Medicine, 74(9), pp. 1331-1341. Lynch, M. E. et al., 2008. A systematic review of the effect of waiting for treatment for chronic pain. Pain, 136 (1-2 ), pp. 97-116. NICE, 2008. Guide to the methods of technology appraisal, London: s.n. NICE, 2013. Guide to the methods of technology appraisal, s.l.: NICE: London. Noseworthy, T. W. et al., 2005. Towards establishing evidence-based benchmarks for acceptable waiting times for joint replacement surgery Calgary, Alberta, s.l.: s.n. Office for National Statistics, 2011. Interim Life Tables, 1980-82 to 2008-10, England: Available: http://www.ons.gov.uk/ons/rel/lifetables/interim-life-tables/2008-2010/rft-ilt-eng-2008-10.xls [Accessed on 17.07.2013]. Oudhoff, J. P. et al., 2007. Waiting for elective general surgery: impact on health related quality of life and psychosocial consequences. BMC Public Health, 164(7). Propper, C., 1995. The disutility of time spent on the United Kingdom's National Health Service waiting lists. Journal of Human Resources, pp. 677-700. Propper, C., Sutton, M., Whitnall, C. & Windmeijer, F., 2010. Incentives and targets in hospital care: evidence from a natural experiment. Journal of Public Economics, pp. 318-335. Sarin, S. et al., 1993. Does venous function deteriorate in patients waiting for varicose vein surgery?. Journal of the Royal Society of Medicine, pp. 8621-23. Smith, P. & Sutton, M., 2013. United Kingdom. Chapter 16. In: L. Siciliani, M. Borowitz & V. Moran, eds. Waiting times policies in the health sector: what works? OECD Health Policy Studies. s.l.:OECD Publishing. Tuominen, U. et al., 2010. Is longer waiting time for total knee replacement associated with health outcomes and medication costs? Randomized clinic. Value in Health, 13(8), pp. 998-1004.
Yüklə 116,56 Kb. Dostları ilə paylaş:
| |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||