Friday, April 8, 2016

Total shoulder arthroplasty - what do patients value?

Are patients willing to pay for total shoulder arthroplasty? Evidence from a discrete choice experiment.

Noting that in Canada, patients desiring total shoulder arthroplasty (TSA) often have to wait a year or more, these authors conducted a discrete choice experiment among patients with endstage shoulder OA currently waiting for TSA to determine patient preferences, specifically comparing out-of-pocket payments for treatment, travel time to hospital, the surgeon's level of experience and wait times.

Respondents were presented with 14 different choice sets, each with 3 options, and they were asked to choose their preferred scenario. An example is shown here:

Of the 137 patients who met the eligibility criteria, 62 (45%) respondents completed the questionnaire. The mean age of participants was 70.9 ± 9.62 years. Fifty-three percent of participants were women, 44% resided within the city of Toronto, 26% had completed postsecondary education, 47% were retired and 18% had an annual household income of more than $100 000. Respondents had been on the wait list for surgery for an average of 16.8 months and had experienced shoulder pain for an average of 6.14 years. The HRQoL EQ-5D score and the QuickDASH score denoted significant disability.

Respondents had a strong preference for an experienced surgeon, while reductions in travel time or wait time were of less importance. Respondents were found to be strongly averse to surgical treatment by a less experienced surgeon and to paying out-of-pocket for their surgical treatment.

The results suggested that respondents were willing to pay $128.50 to reduce their travel time to the hospital for surgical treatment by 1 hour and $76.40 to have their wait time for surgical treatment decreased by 1 month. All else being equal, respondents preferred to drive more than 7 hours to the hospital for surgical treatment or wait more than 13 months than pay $1000 out of pocket for their surgical treatment. Respondents were willing to drive an additional 3 hours to the hospital for surgical treatment or wait an additional 5.5 months to have their treatment performed by an experienced surgeon as opposed to treatment by a surgeon of average experience.

Comment: This paper provides an interesting insight into the Canadian health care system and the care priorities of Canadian citizens. We were struck by the willingness of these patients to wait long periods for their surgery and their preference for experienced surgical care.