Cost of Waiting on an Orthopaedic Waiting List: a scoping review

Abstract

Background: Approximately 30% Australians suffer from arthritis and other musculoskeletal disorders. From 2003-2033 there is a predicted 223% increase in expenditure on health management of musculoskeletal disorders. There is evidence of increasing prevalence of orthopaedic complaints, in longer waiting lists for specialist consultations in public hospital outpatient clinics. Little is known about the costs and ramifications of waiting for orthopaedic consultations.
 Aim: Establish what is known about the direct and indirect costs of being placed on a waiting list for an orthopaedic consultation.
 Method: Patient and Outcome search strategy of Medline, Embase, Pubmed, NHS Economic evaluation database (NHS-EED) from each database inception date. Handsearching of reference lists of included papers alsooccurred. A realist synthesis framework underpinned the review, using a ubiquitous patient journey to map available literature on the impact of waiting. Hierarchy of evidence was reported using NHMRC criteria andarticles critically appraised using either the PEDRo or CASP criteria (relevant to the design). A purpose-built data extraction instrument was developed.
 Results: We identified 786 studies, of which 139 were relevant, including a systematic review (Hoogeboom et al) with 15 included articles which were added to the list of eligible papers (and the review itself deleted), leaving 153 included articles; 17 were relevant to the review. Fourteen papers reported on quality of life and four reported on costs, two of these papers reported on both and all were of low to moderate quality. The research was not based on a comprehensive understanding of the stages of waiting, and there were inconclusive outcomes for quality of life and cost.
 Conclusion: There is scant evidence of the impact on quality of life and costs of waiting for orthopaedic outpatient appointments. Future research should aim for improved methodological quality and use patientfocused quality of life measures, and validated measures of cost.
 Abbreviations: NHMRC – National Health and Medical Research Council; PROMS – Patient Related Outcome Measures; QoL – Quality of Life; WOMAC – Western Ontario and McMaster Universities Osteoarthritis Index; YLD – Years Lived With Disability

What is the current evidence for cost of waiting on the outpatient list for management/treatment of orthopaedic/musculoskeletal complaints? A systematic review

“…The review was registered with Prospero (registration CRD42016047332), and the complete search methods were reported previously [15]. Database were searched from inception until February 2018.…”

“…The studies comprised one RCT [20] (published 2009) and three prospective observational studies [10,21,22] (published 2005, 2002, 2012 respectively). All studies were of moderate methodological quality [15] (Table 1).…”

“…To our knowledge, there is no review to date that explores the costs of waiting for specialist consultation for orthopaedic conditions. This paper reports on a subset of data from a larger systematic scoping review, which investigated the peer-reviewed literature on the impact of waiting for orthopaedic care [15]. This paper reports on available data on the costs of being placed on an outpatient waiting list for orthopaedic consultation to individuals, healthcare systems and society.…”

The impact of wait time on patient outcomes in knee and hip replacement surgery: a scoping review protocol

“…In a typical referral pathway for patients who undergo hip and knee replacement surgery, patients initially see their primary health provider and are referred to an outpatient orthopedic clinic for physical assessment and diagnostic imaging tests [7]. Once a decision to undergo surgery is made, the patient is placed on a waiting list.…”