title: The Impact of Waiting Time on Health Gains from Surgery: Evidence from a National Patient-reported Outcome Dataset.
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.
authors.affiliation: University of Leeds, Academic Unit of Health Economics, Leeds Institute of Health Sciences, Leeds, UK.
authors.forename: Silviya
authors.initials: S
authors.lastname: Nikolova
authors.affiliation: 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.
authors.forename: Mark
authors.initials: M
authors.lastname: Harrison
authors.affiliation: University of Manchester, Manchester Centre for Health Economics, Institute of Population Health, Manchester, UK.
authors.forename: Matt
authors.initials: M
authors.lastname: Sutton
mesh_terms: D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000706:statistics & numerical data; D019645:Arthroplasty, Replacement, Knee / Q000706:statistics & numerical data; D017558:Elective Surgical Procedures / Q000523:psychology / Q000706:statistics & numerical data*; D006292:Health Priorities / Q000706:statistics & numerical data*; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006801:Humans; D000071066:Patient Reported Outcome Measures; D011795:Surveys and Questionnaires; D013997:Time Factors; D014850:Waiting Lists
keywords: patient-reported outcome measures; surgery; waiting times