IDEAS home Printed from https://ideas.repec.org/a/spr/aphecp/v23y2025i5d10.1007_s40258-025-00975-8.html
   My bibliography  Save this article

The Cost Effectiveness of Elective Surgical Procedures with Longer NHS Waiting Lists: A Targeted Review

Author

Listed:
  • Laura A. Trigg

    (University of Exeter)

  • Caroline Farmer

    (University of Exeter)

  • Madhusubramanian Muthukumar

    (University of Exeter)

  • Edward C. F. Wilson

    (University of Exeter)

  • Alan Lovell

    (University of Exeter)

  • Dawn Lee

    (University of Exeter)

Abstract

Objectives Our aim was to review the evidence for the cost effectiveness of elective surgeries with long waiting lists within the NHS in England. This is to inform understanding of national spending priorities in the context of significant demand for elective surgeries and to inform the debate on appropriate cost-effectiveness thresholds across healthcare decision making. Methods We conducted a targeted literature review to identify published cost-effectiveness analyses for nine elective procedures with long waiting lists in the NHS, selected based on previous reviews. These were percutaneous coronary intervention (PCI), coronary artery bypass graft surgery (CABG), hysterectomy, cholecystectomy, knee replacement, groin hernia repair, hip replacement, prostatectomy, and cataract surgery. We made comparisons adjusted for currency and price year (2024). Results We identified 21 evaluations; in these, the cost effectiveness of surgeries was compared with no surgery (n = 9), medical management (n = 5), and between early and delayed surgery (n = 10). The evaluations reported that almost all procedures would be considered cost effective yielding incremental cost-effectiveness ratios (ICERs) below £20,000 per quality-adjusted life-year gained. Cholecystectomy, prostatectomy, hip and knee replacement surgeries were associated with ICERs of between £5,000 and £10,000. Conclusions These findings offer insights for policymakers on optimising finite healthcare resources, particularly post-COVID-19, with surgical waiting lists a priority for the NHS. Prioritising these elective procedures is likely to be a highly cost-effective use of NHS resources. Allocation of investment to areas that are more cost effective than others is likely to increase the efficiency of the NHS, resulting in a net health gain compared with the reimbursement of less cost-effective interventions.

Suggested Citation

  • Laura A. Trigg & Caroline Farmer & Madhusubramanian Muthukumar & Edward C. F. Wilson & Alan Lovell & Dawn Lee, 2025. "The Cost Effectiveness of Elective Surgical Procedures with Longer NHS Waiting Lists: A Targeted Review," Applied Health Economics and Health Policy, Springer, vol. 23(5), pages 779-796, September.
    • Handle: RePEc:spr:aphecp:v:23:y:2025:i:5:d:10.1007_s40258-025-00975-8
    DOI: 10.1007/s40258-025-00975-8
    as

    Download full text from publisher

    File URL: http://link.springer.com/10.1007/s40258-025-00975-8
    File Function: Abstract
    Download Restriction: Access to the full text of the articles in this series is restricted.
    File URL: https://libkey.io/10.1007/s40258-025-00975-8?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    As the access to this document is restricted, you may want to

    for a different version of it.

    References listed on IDEAS

    as
    1. Siciliani, Luigi & Hurst, Jeremy, 2005. "Tackling excessive waiting times for elective surgery: a comparative analysis of policies in 12 OECD countries," Health Policy, Elsevier, vol. 72(2), pages 201-215, May.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Woorim Kim & Kyu-Tae Han & Seungju Kim, 2021. "Do Patients Residing in Provincial Areas Transport and Spend More on Cancer Treatment in Korea?," IJERPH, MDPI, vol. 18(17), pages 1-11, September.
    2. Askildsen, Jan Erik & Holmås, Tor Helge & Kaarboe, Oddvar, 2010. "Prioritization and patients' rights: Analysing the effect of a reform in the Norwegian hospital sector," Social Science & Medicine, Elsevier, vol. 70(2), pages 199-208, January.
    3. Gutacker, Nils & Siciliani, Luigi & Cookson, Richard, 2016. "Waiting time prioritisation: Evidence from England," Social Science & Medicine, Elsevier, vol. 159(C), pages 140-151.
    4. Domenico Lisi & Giacomo Pignataro, 2021. "A note on the trade‐off between waiting times and quality in a constrained hospital market," Health Economics, John Wiley & Sons, Ltd., vol. 30(1), pages 180-185, January.
    5. Silviya Nikolova; & Arthur Sinko; & Matt Sutton;, 2012. "Do maximum waiting times guarantees change clinical priorities? A Conditional Density Estimation approach," Health, Econometrics and Data Group (HEDG) Working Papers 12/07, HEDG, c/o Department of Economics, University of York.
    6. Luyi Yang & Laurens G. Debo & Varun Gupta, 2019. "Search Among Queues Under Quality Differentiation," Management Science, INFORMS, vol. 65(8), pages 3605-3623, August.
    7. Siciliani, L., 2016. "Waiting Time Policies in the Health Sector," Seminar Briefing 001724, Office of Health Economics.
    8. Pengfei Guo & Christopher S. Tang & Yulan Wang & Ming Zhao, 2019. "The Impact of Reimbursement Policy on Social Welfare, Revisit Rate, and Waiting Time in a Public Healthcare System: Fee-for-Service Versus Bundled Payment," Service Science, INFORMS, vol. 21(1), pages 154-170, January.
    9. Melberg, Hans Olav & Beck Olsen, Camilla & Pedersen, Kine, 2016. "Did hospitals respond to changes in weights of Diagnosis Related Groups in Norway between 2006 and 2013?," Health Policy, Elsevier, vol. 120(9), pages 992-1000.
    10. Rotstein, Dalia L. & Alter, David A., 2006. "Where does the waiting list begin? A short review of the dynamics and organization of modern waiting lists," Social Science & Medicine, Elsevier, vol. 62(12), pages 3157-3160, June.
    11. Granlund David & Wikström Magnus, 2016. "Public Provision and Cross-Border Health Care," Forum for Health Economics & Policy, De Gruyter, vol. 19(2), pages 157-177, December.
    12. Glenis J. Crane & Steven M. Kymes & Janet E. Hiller & Robert Casson & Adam Martin & Jonathan D. Karnon, 2013. "Accounting for Costs, QALYs, and Capacity Constraints," Medical Decision Making, , vol. 33(8), pages 986-997, November.
    13. Damien Besancenot & Karine Lamiraud & Radu Vranceanu, 2023. "A model for dual health care market with congestion differentiation," Journal of Economics & Management Strategy, Wiley Blackwell, vol. 32(2), pages 400-423, April.
    14. Fanwen Meng & Kiok Teow & Chee Ooi & Bee Heng & Seow Tay, 2015. "Analysis of patient waiting time governed by a generic maximum waiting time policy with general phase-type approximations," Health Care Management Science, Springer, vol. 18(3), pages 267-278, September.
    15. Siciliani, Luigi & Moran, Valerie & Borowitz, Michael, 2014. "Measuring and comparing health care waiting times in OECD countries," Health Policy, Elsevier, vol. 118(3), pages 292-303.
    16. Chiara Canta, 2021. "Efficiency, access, and the mixed delivery of health care services," Journal of Public Economic Theory, Association for Public Economic Theory, vol. 23(3), pages 510-533, June.
    17. Huw Dixon & Luigi Siciliani, 2009. "Waiting Time Targets in Healthcare Markets: How Long Are We Waiting?," Discussion Papers 09/05, Department of Economics, University of York.
    18. Carnazza, Giovanni & Liberati, Paolo & Resce, Giuliano, 2023. "Income-related unmet needs in the European countries," Socio-Economic Planning Sciences, Elsevier, vol. 87(PA).
    19. Sofia Dimakou & Ourania Dimakou & Henrique S. Basso, 2015. "The Asymmetric Effects of Waiting Time Targets in Health Care," BCAM Working Papers 1502, Birkbeck Centre for Applied Macroeconomics.
    20. Megan Gu & Meliyanni Johar, 2016. "Economic Incentives in Health Care: The Case of Assigning Patients as “Not Ready for Care”," Economic Papers, The Economic Society of Australia, vol. 35(2), pages 130-141, June.

    More about this item

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:spr:aphecp:v:23:y:2025:i:5:d:10.1007_s40258-025-00975-8. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Sonal Shukla or Springer Nature Abstracting and Indexing (email available below). General contact details of provider: http://www.springer.com .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.