Prioritising elective care: A cost utility analysis of orthopaedics in the north west of England

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.