Measuring the impact of delayed access to elective cholecystectomy through patient's cost-utility: an observational cohort study

Int J Qual Health Care. 2021 Feb 8;33(1):mzab018. doi: 10.1093/intqhc/mzab018.

Abstract

Background: Deferral of surgeries due to COVID-19 has negatively affected access to elective surgery and may have deleterious consequences for patient's health. Delays in access to elective surgery are not uniform in their impact on patients with different attributes. The objective of this study is to measure the change in patient's cost utility due to delayed elective cholecystectomy.

Methods: This study is based on retrospective analysis of a longitudinal sample of participants who have had elective cholecystectomy and completed the EQ-5D(3L) measuring health status preoperatively and postoperatively. Emergent cases were excluded. Patients younger than 19 years of age, unable to communicate in English or residing in a long-term care facility were ineligible. Quality-adjusted life years attributable to cholecystectomy were calculated by comparing health state utility values between the pre- and postoperative time points. The loss in quality-adjusted life years due to delayed access was calculated under four assumed scenarios regarding the length of the delay. The mean cost per quality-adjusted life years are shown for the overall sample and by sex and age categories.

Results: Among the 646 eligible patients, 30.1% of participants (N = 195) completed their preoperative and postoperative EQ-5D(3L). A delay of 12 months resulted in a mean loss of 6.4%, or 0.117, of the quality-adjusted life years expected without the delay. Among patients older than 70 years of age, a 12-month delay in their surgery corresponded with a 25.1% increase in the cost per quality-adjusted life years, from $10 758 to $13 463.

Conclusions: There is a need to focus on minimizing loss of quality of life for patients affected by delayed surgeries. Faced with equal delayed access to elective surgery, triage may need to prioritize older patients to maximize their health over their remaining life years.

Keywords: COVID-19; EQ-5D(3L); cholecystectomy; delayed surgery; quality adjusted life year.

Publication types

  • Observational Study

MeSH terms

  • Age Factors
  • Aged
  • Aged, 80 and over
  • COVID-19 / epidemiology*
  • Canada / epidemiology
  • Cholecystectomy / psychology*
  • Cholecystectomy / statistics & numerical data
  • Comorbidity
  • Elective Surgical Procedures / psychology*
  • Elective Surgical Procedures / statistics & numerical data
  • Female
  • Health Expenditures
  • Health Status
  • Humans
  • Male
  • Middle Aged
  • Patient Reported Outcome Measures
  • Quality of Life / psychology*
  • Quality-Adjusted Life Years
  • Retrospective Studies
  • SARS-CoV-2