Table 1.
Unit costs for total hip and knee replacement resource use
| Resource use | Unit cost | Assumption | Source |
|---|---|---|---|
| Initial inpatient admission | |||
| Theatre (per minute) | £14.22 | Includes implant cost, staff time, overheads, consumables, facilities | North Bristol NHS Trust Finance department |
| Injection of local anaesthesia infiltration (LAI) | £2.00 | Box of bupivicaine with adrenaline 0.25 %/1 in 200,000 is £20.00; one box contains 10 ampoules | North Bristol NHS Trust Finance department, management, and procurement |
| Recovery (per minute) | £3.84 | Includes staff time with overheads, consumables, facilities, and medications administered during stay; base cost per minute | North Bristol NHS Trust Finance department |
| Day in general orthopaedics ward: Frome, Severn, Kennett, and Cardiac Care Unit | £311 | Includes staff time with overheads, consumables, facilities, and medications administered during stay; base cost per day | North Bristol NHS Trust Finance department |
| Day in other orthopaedics ward: Chew | £250 | Includes staff time with overheads, consumables, facilities, and medications administered during stay; base cost per day | North Bristol NHS Trust Finance department |
| Day in high dependency unit | £1,356 | Includes staff time with overheads, consumables, facilities, and medications administered during stay; base cost per day | North Bristol NHS Trust Finance department |
| Inpatient admissions following discharge from initial surgery | |||
| Revision surgery – Total knee replacement (TKR) | £9,439 | HB22A major knee procedures for non-trauma, with major comorbidity and complication (CC) | NHS Reference Costs 2012–2013: Non-elective long stay |
| Revision surgery – Total hip replacement (THR) | £8,890 | HB12A major hip procedures for non-trauma, with major CC | NHS Reference Costs 2012–2013: Non-elective long stay |
| Manipulation under anaesthetic – TKR | £2,044 | HB24C minor knee procedures for non-trauma, category 2, without CC | NHS Reference Costs 2012–2013: Non-elective long stay |
| Infections | £4,124 | Infections of bones or joints, with CC Score 5–8 | NHS Reference Costs 2012–2013: Non-elective long stay |
| Day case procedures – TKR | £655 | Day case: HB29Z minimal knee procedures for non-trauma | NHS Reference Costs 2012–2013: Non-elective day case |
| Day case procedures – THR | £788 | Day case: HB19Z minimal hip procedures for non-trauma | NHS Reference Costs 2012–2013: Non-elective day case |
| Nights in hospital for other admissions a | £311 | Unit cost based on SMH cost per night in general orthopaedics ward | North Bristol NHS Trust Finance department |
| A and E and outpatient visits | |||
| Accident and emergency | £117 | Average of all accident and emergency visits | NHS Reference Costs 2012–2013: Outpatient appointments: 180 Accident & Emergency |
| Trauma and orthopaedics – consultant led | £102 | Non-admitted face to face attendance, follow-up, consultant led | NHS Reference Costs 2012–2013: Outpatient appointments: 110 Trauma & Orthopaedics |
| Trauma and orthopaedics – non-consultant led | £90 | Non-admitted face to face attendance, follow-up, non-consultant led | NHS Reference Costs 2012–2013: Outpatient appointments: 110 Trauma & Orthopaedics |
| Physiotherapy – non-consultant led | £39 | Non-admitted face to face attendance, follow-up, non-consultant led | NHS Reference Costs 2012–2013: Outpatient appointments: 650 Physiotherapy |
| General Medicine – consultant led | £145 | Non-admitted face to face attendance, follow-up, consultant led | NHS Reference Costs 2012–2013: Outpatient appointments: 300 General Medicine |
| Neurology – consultant led | £157 | Non-admitted face to face attendance, follow-up, consultant led | NHS Reference Costs 2012–2013: Outpatient appointments: 400 Neurology |
| Respiratory – consultant led | £137 | Non-admitted face to face attendance, first appointment, consultant led | NHS Reference Costs 2012–2013: Outpatient appointments: 340 Respiratory Medicine |
| Pain management – consultant led | £136 | Non-admitted face to face attendance, follow-up, consultant led | NHS Reference Costs 2012–2013: Outpatient appointments: 191 Pain management |
| Vascular – consultant led | £133 | Non-admitted face to face attendance, follow-up, consultant led | NHS Reference Costs 2012–2013: Outpatient appointments: 107 Vascular surgery |
| Dermatology – consultant led | £95 | Non-admitted face to face attendance, follow-up, consultant led | NHS Reference Costs 2012–2013: Outpatient appointments: 330 Dermatology |
| Haematology – consultant led | £209 | Non-admitted face to face attendance, follow-up, consultant led | NHS Reference Costs 2012–2013: Outpatient appointments: 303 Clinical Haematology |
| Community based health services | |||
| GP surgery visit | £45 | Base cost per patient contact with GP with qualifications, including direct care staff costs, lasting 11.7 min | Personal Social Services Research Unit (PSSRU) 2013: 10.8b General practitioner |
| GP home visit | £114 | Base cost per out of surgery visit with GP with qualifications, including direct care staff costs, lasting 23.4 min | PSSRU 2013: 10.8b General practitioner |
| Phoned GP for advice | £27 | Base cost per telephone consultation with GP with qualifications, including direct care staff costs, lasting 7.1 min | PSSRU 2013: 10.8b General practitioner |
| GP Practice nurse visit | £13.43 | Based on 15.5 min per surgery consultation using the base cost (£52) of one hour of face-to-face contact with GP nurse with qualifications | PSSRU 2013: 10.6 Nurse (GP practice) |
| Phoned GP practice nurse for advice | £4 | Based on 6 min of GP nurse time using the base cost (£40) of 1 hour of GP nurse time with qualifications | PSSRU 2013: 10.6 Nurse (GP practice) |
| Repeat prescription (without seeing doctor) | £11.40 | Based on 3 min of GP time, using the base cost of 1 minute GP patient contact time (£3.80), with qualifications, including direct care staff costs | PSSRU 2013: 10.8b General practitioner |
| District nurse | £18.08 | Based on the assumption that the duration of a district nurse visit is the same as GP nurse visit (15.5 min) and using the base cost of 1 hour of community nurse visit (£70) with qualifications including travel | PSSRU 2013: 10.1 Community nurse |
| Occupational therapist at home/GP surgery/clinic | £17 | Based on 30 min contact using the base cost (£34) of 1 hour of occupational therapist contact with qualifications | PSSRU 2013: 9.2 NHS community occupational therapist |
| Community physiotherapist at home/GP surgery/clinic | £17 | Based on 30 min contact using the base cost (£34) of 1 hour of physiotherapist contact with qualifications | PSSRU 2013: 9.1 Community physiotherapist |
| Prescriptions costs per consultation | £44.64 | Prescription costs per consultation (net ingredient cost) | PSSRU 2013:10.8b General practitioner |
| Social services | |||
| Home care worker (home help) provided by social services | £24 | Based on 1 hour of face-to-face weekday contact for independent sector home care provided for social services | PSSRU 2013: 11.6 |
| Food at home service (meals on wheels) | £3.14 | Based on one meal a day using the Meals on Wheels average weekly cost (2012/2013) of £44, assuming two meals per day, 7 days a week | PSSRU 2013: 8.1.1 Community care package for older people: very low cost |
| Social worker visits | £113 | Based on a 30 min visit using the base cost (£226) of 1 hour of face-to-face contact of social worker with qualifications | PSSRU 2013: 11.2 Social worker (adult services) |
| Social worker telephone calls | £39.50 | Based on a 30 min telephone call using a base cost (£79) of 1 hour of client-related work of a social worker with qualifications | PSSRU 2013: 11.2 Social worker (adult services) |
| Home changes and equipment provided by social services: | All unit costs for home changes and equipment are based on 3-month loan period, assuming a 24 months life span | ||
| Toilet seat or toilet raiser | £1.80 | Cost of equipment £14 | NRS price – equipment provider for North Bristol NHS Trust |
| Dressing aids: socks, shoes, etc. | £1.25 | Cost of equipment £10 | NRS price – equipment provider for North Bristol NHS Trust |
| Furniture raisers | £2.48 | Cost of equipment £20 | NRS price – equipment provider for North Bristol NHS Trust |
| Perching stool | £6.00 | Cost of equipment £48 | NRS price – equipment provider for North Bristol NHS Trust |
| Walker or trolley | £7.50 | Cost of equipment £60 | NRS price – equipment provider for North Bristol NHS Trust |
| Crutches | £3.75 | Cost of equipment £30 | NRS price – equipment provider for North Bristol NHS Trust |
| Commode | £5.69 | Cost of equipment £46 | NRS price – equipment provider for North Bristol NHS Trust |
| Rails and hand grips | £2.85 | Cost of equipment £23 | NRS price – equipment provider for North Bristol NHS Trust |
| Bath boards | £3.00 | Cost of equipment £24 | NRS price – equipment provider for North Bristol NHS Trust |
| Hospital bed at home | £59.88 | Cost of equipment £479 | Online search for procurement prices (cheaper range) |
| Bath lift | £44.75 | Cost of equipment £358 | Online search for procurement prices (cheaper range) |
| Chair and stair lift | £125.00 | Cost of equipment £1000 | Online search for procurement prices (cheaper range) |
a When healthcare resource group codes could not be derived because of insufficient information, inpatient admissions were valued multiplying the number of nights admitted to a ward by the cost of a night in a general orthopaedics ward provided by the North Bristol Trust finance department