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

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.