Abstract
STUDY OBJECTIVE: To produce a priority list for purchasers to use when purchasing elective care in the speciality of orthopaedics so that efficiency in health care purchasing (that is, maximising the benefit per unit of resource available for the resident population) can be achieved. DESIGN: The study used cost utility analysis in the elective speciality of orthopaedics. The diagnostic groups in the study were chosen on the basis of those conditions that constituted the greatest proportion of the orthopaedic waiting list, and consequently the greatest proportion of activity within the speciality. Costs were derived by two methods: the extra contractual referral tariff (ECR) and individual patient based costings. Outcome was assessed before surgery and again approximately six months afterwards. The outcome of the procedures was derived in two ways: Rosser and EuroQol indices. SETTING: The study took place at Wrightington hospital, a specialist orthopaedic hospital in north west England. PATIENTS: Prospective assessments were obtained from 99 patients for nine orthopaedics procedures. All the patients were individually interviewed on each occasion. Rosser and EuroQol assessments were completed for each patient by the patient and the patient's consultant before and after surgery. MAIN RESULTS: Priority lists presenting cost utility rankings for each of the procedures were derived from the patients' and consultants' assessments. CONCLUSIONS: It is feasible to generate priority lists in a systematic way. Purchasers may then use the results from these priority lists to help them maximise the benefits per unit of resource for their resident population.
Full text
PDFSelected References
These references are in PubMed. This may not be the complete list of references from this article.
- Brooks R. G., Jendteg S., Lindgren B., Persson U., Björk S. EuroQol: health-related quality of life measurement. Results of the Swedish questionnaire exercise. Health Policy. 1991 Jun;18(1):37–48. doi: 10.1016/0168-8510(91)90142-k. [DOI] [PubMed] [Google Scholar]
- Daellenbach H. G., Gillespie W. J., Crosbie P., Daellenbach U. S. Economic appraisal of new technology in the absence of survival data--the case of total hip replacement. Soc Sci Med. 1990;31(12):1287–1293. doi: 10.1016/0277-9536(90)90067-3. [DOI] [PubMed] [Google Scholar]
- Dixon J., Welch H. G. Priority setting: lessons from Oregon. Lancet. 1991 Apr 13;337(8746):891–894. doi: 10.1016/0140-6736(91)90213-9. [DOI] [PubMed] [Google Scholar]
- Eftekhar N. S. Long-term results of cemented total hip arthroplasty. Clin Orthop Relat Res. 1987 Dec;(225):207–217. [PubMed] [Google Scholar]
- Essink-Bot M. L., Bonsel G. J., van der Maas P. J. Valuation of health states by the general public: feasibility of a standardized measurement procedure. Soc Sci Med. 1990;31(11):1201–1206. doi: 10.1016/0277-9536(90)90124-b. [DOI] [PubMed] [Google Scholar]
- Gudex C., Williams A., Jourdan M., Mason R., Maynard J., O'Flynn R., Rendall M. Prioritising waiting lists. Health Trends. 1990;22(3):103–108. [PubMed] [Google Scholar]
- Nord E. EuroQol: health-related quality of life measurement. Valuations of health states by the general public in Norway. Health Policy. 1991 Jun;18(1):25–36. doi: 10.1016/0168-8510(91)90141-j. [DOI] [PubMed] [Google Scholar]
- Walker S. J., Sharma P., Parr N., Cavendish M. E. The long-term results of the Liverpool Mark II knee prosthesis. J Bone Joint Surg Br. 1986 Jan;68(1):111–116. doi: 10.1302/0301-620X.68B1.3941126. [DOI] [PubMed] [Google Scholar]
- Wilcock G. K. A comparison of total hip replacement in patients aged 69 years or less and 70 years or over. Gerontology. 1981;27(1-2):85–88. doi: 10.1159/000212454. [DOI] [PubMed] [Google Scholar]