Predicting joint replacement waiting times

Cipriano, Lauren E.; Chesworth, Bert M.; Anderson, Chris K.; Zaric, Gregory S.

doi:10.1007/s10729-007-9013-z

Cited by 18 publications

(11 citation statements)

References 69 publications

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“…Increasing the size of the workforce has been discussed and projections in Canada suggest that the annual supply of surgeries must increase by 12% or greater each year to prevent further increases in mean waiting times [34]. Payment reform must also be carefully crafted to incentivize appropriate utilization.…”

Section: Discussionmentioning

confidence: 99%

Economic evaluation of access to musculoskeletal care: the case of waiting for total knee arthroplasty

Mather

Hug

Orlando

et al. 2014

BMC Musculoskelet Disord

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BackgroundThe projected demand for total knee arthroplasty is staggering. At its root, the solution involves increasing supply or decreasing demand. Other developed nations have used rationing and wait times to distribute this service. However, economic impact and cost-effectiveness of waiting for TKA is unknown.MethodsA Markov decision model was constructed for a cost-utility analysis of three treatment strategies for end-stage knee osteoarthritis: 1) TKA without delay, 2) a waiting period with no non-operative treatment and 3) a non-operative treatment bridge during that waiting period in a cohort of 60 year-old patients. Outcome probabilities and effectiveness were derived from the literature. Costs were estimated from the societal perspective with national average Medicare reimbursement. Effectiveness was expressed in quality-adjusted life years (QALYs) gained. Principal outcome measures were average incremental costs, effectiveness, and quality-adjusted life years; and net health benefits.ResultsIn the base case, a 2-year wait-time both with and without a non-operative treatment bridge resulted in a lower number of average QALYs gained (11.57 (no bridge) and 11.95 (bridge) vs. 12.14 (no delay). The average cost was $1,660 higher for TKA without delay than wait-time with no bridge, but $1,810 less than wait-time with non-operative bridge. The incremental cost-effectiveness ratio comparing wait-time with no bridge to TKA without delay was $2,901/QALY. When comparing TKA without delay to waiting with non-operative bridge, TKA without delay produced greater utility at a lower cost to society.ConclusionsTKA without delay is the preferred cost-effective treatment strategy when compared to a waiting for TKA without non-operative bridge. TKA without delay is cost saving when a non-operative bridge is used during the waiting period. As it is unlikely that patients waiting for TKA would not receive non-operative treatment, TKA without delay may be an overall cost-saving health care delivery strategy. Policies aimed at increasing the supply of TKA should be considered as savings exist that could indirectly fund those strategies.

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Section: Discussionmentioning

confidence: 99%

Economic evaluation of access to musculoskeletal care: the case of waiting for total knee arthroplasty

Mather

Hug

Orlando

et al. 2014

BMC Musculoskelet Disord

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“…26 Surgeons in Ontario were grouped into 25 service providing regions: 11 teaching hospitals and 14 groups of community hospitals organized on the basis of Ontario's 14 Local Health Integration Networks. 30 The Ontario Joint Replacement Registry (OJRR) was a clinical registry that collected demographic, medical, surgical, and outcomes information on patients who received TJR in Ontario from 1999 to 2006.…”

Section: Methodsmentioning

confidence: 99%

“…11 One study showed that if 16% increases could be maintained for several years then, within 7 years, 90% of patients would receive surgery within 6 months of their decision to have surgery. 26 However, human resource shortages in orthopedics, 27 anesthesiology, 28 and nursing 29 may prevent this high level of sustained growth.…”

mentioning

confidence: 99%

An Evaluation of Strategies to Reduce Waiting Times for Total Joint Replacement in Ontario

Cipriano

Chesworth²,

Anderson³

et al. 2008

Medical Care

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Dramatically increasing the supply of joint replacement surgeries or diverting demand for surgeries to other jurisdictions will reduce waiting times for total joint replacement surgery. Introducing a strictly adhered to patient prioritization scheme will ensure that more patients receive surgery within severity-specific waiting time targets. Implementing a waiting time guarantee for all patients will not reduce waiting times--it will only shuffle waiting times from some patients to others. To reduce waiting times to clinically acceptable levels within 10 years, increases in the number of surgeries provided greater than those observed historically or reductions in demand are needed.

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“…In this journal, the literature review in a recent paper [12] includes an excellent discussion and a list of more than two dozen papers where mathematical models have been used to address issues related to health care resources. In particular, Cipriano et al [12] states that "Queuing theory has been applied to many aspects of heath care including emergency rooms [ It has been suggested that the proper application of a pertinent mathematical model is like a good caricature [13]. In the latter case, the image that results from the use of a small number of well-drawn pen strokes manages to convey the identity of the intended individual.…”

Section: Modelling the Waiting Timesmentioning

confidence: 99%

Waiting for liver transplantation in Canada: waitlist history 2000–2004 and sensitivity analysis for the future

Stanford

Renouf

McAlister

2008

Health Care Manage Sci

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This study comprises a historical review of liver transplants performed in Canada during [2000][2001][2002][2003][2004], and sensitivity analyses to assess the impact of possible changes in the operation of the waitlists. In the first part, overall statistics are reported, and the notable impact that blood type plays in affecting waiting time is discussed. Waiting times and numbers of transplants are also reported by gender, age, and geographic region (waitlist), and statistical analyses of the patient placement and cadaveric donations processes are performed. These analyses establish that the service times of an appropriate queuing model are closely approximated by an exponential distribution. Consequently, the resulting distribution for the waiting time from placement until transplant is well described by a different exponential distribution. The GI/M/1 queuing model is then used to perform a number of sensitivity analyses. The sensitivity analyses attempt to quantify the impact of no change in policy via a lottery system, and likely increases in cadaveric and/or living donor sources that would be needed to bring stability to the system. The results can be used by relevant authorities, together with information on success rates for publicity campaigns and living donor matching campaigns, to assess where further efforts should be made to reduce waiting times.

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Predicting joint replacement waiting times

Cited by 18 publications

References 69 publications

Economic evaluation of access to musculoskeletal care: the case of waiting for total knee arthroplasty

Economic evaluation of access to musculoskeletal care: the case of waiting for total knee arthroplasty

An Evaluation of Strategies to Reduce Waiting Times for Total Joint Replacement in Ontario

Waiting for liver transplantation in Canada: waitlist history 2000–2004 and sensitivity analysis for the future

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