Introduction and Aims: To define the economic and health costs of waiting for THJR surgery.

Method: A prospective cohort of 122 patients requiring primary total hip arthroplasty (HA) was recruited from four hospitals. Health-related quality of life (HRQL) using self-completed WOMAC questionnaires was assessed monthly from enrolment pre-operatively to six months post-surgery. Monthly cost diaries were used to record medical, personal and other costs. Data was analysed using PC-SAS to test the strength of associations between costs and waiting times, and changes in HRQL pre- and post-surgery.

Results: The mean waiting time was 5.2 months, and the mean cost of waiting for surgery was NZ$1376 per person per month, with medical, personal, and social costs contributing NZ$404, NZ$399, NZ$573, respectively. Waiting for more than six months was associated with an increased cost of NZ$730 per patient per month for a total cost of NZ$2177 per patient per month. Age was correlated with greater loss of income and higher medical costs. An incremental improvement over time in WOMAC scores post-operatively was identified. Older age, community services card use and a greater number of months waiting were negatively correlated with post-surgical improvement.

Conclusion: Longer waits for HA incur greater economic costs and impact on patient recovery. This shows that shorter waiting time for HA significantly reduces costs to individuals and society and improves health outcomes.

This study explores the outcomes of a pilot project involving five Orthopaedic services in developing approaches to improve the consistency and equity of clinical decision-making for access to treatment.

The pilot was conducted in two phases; the first involved development of retrospective and prospective data collection and analysis tools including use of:

The Orthopaedic Integrated CPAC tool:

Large variations in internal equity were found within most services. Additionally a significant, systemic equity issue is apparent between patients prioritised for major joints versus other conditions. The pilot has made useful progress in developing improvement tools and processes targeting electives service management, improvements in prioritisation and clinical decision making, and funding and planning decisions. The pilot has also raised issues for further CPAC development and national service policy.

The purpose was to define the economic and health costs of waiting for total hip joint replacement surgery. A prospective cohort of 122 patients requiring primary hip arthroplasty (HA) was recruited from four hospitals in the lower North Island. Health related quality of life (HRQL), using self-completed WOMAC questionnaires, was assessed monthly from enrolment pre-operatively to six months post surgery. Monthly cost diaries were used to record medical, personal and other costs. Data was analysed using PC-SAS to test the strength of associations between costs and waiting times, and changes in HRQL pre- and post-surgery.

The mean waiting time was 5.2 months and mean cost of waiting for surgery was $1,376 per person per month (pp pm) with medical, personal and social costs contributing $404, $399, and $573, respectively. Waiting more than 6 months was associated with an increased cost of $730 pp pm for a total cost of $2177 pp pm (p< 0.003). Age was correlated with greater loss of income (< 65 years) (p=0.001) and higher medical costs (< 65 years) (p=0.08). An incremental improvement over time in WOMAC scores post-operatively was identified (p=0.0001). Older age (p=0.01), community services card use (p=0.003) and a greater number of months waiting (p=0.1) were negatively correlated with post-surgical improvement after adjusting for other variables. Longer waits for HA incur greater economic costs and impact on patient recovery. This lends weight to the view that a shorter waiting time for HA significantly reduces costs to individuals and society and improves health outcomes.