Minimizing population health loss due to scarcity in OR capacity: validation of quality of life input

Abstract

Objectives A previously developed decision model to prioritize surgical procedures in times of scarce surgical capacity used quality of life (QoL) primarily derived from experts in one center. These estimates are key input of the model, and might be more context-dependent than the other input parameters (age, survival). The aim of this study was to validate our model by replicating these QoL estimates. Methods The original study estimated QoL of patients in need of commonly performed procedures in live expert-panel meetings. This study replicated this procedure using a web-based Delphi approach in a different hospital. The new QoL scores were compared with the original scores using mixed effects linear regression. The ranking of surgical procedures based on combined QoL values from the validation and original study was compared to the ranking based solely on the original QoL values. Results The overall mean difference in QoL estimates between the validation study and the original study was − 0.11 (95% CI: -0.12 - -0.10). The model output (DALY/month delay) based on QoL data from both studies was similar to the model output based on the original data only: The Spearman’s correlation coefficient between the ranking of all procedures before and after including the new QoL estimates was 0.988. Discussion Even though the new QoL estimates were systematically lower than the values from the original study, the ranking for urgency based on health loss per unit of time delay of procedures was consistent. This underscores the robustness and generalizability of the decision model for prioritization of surgical procedures.

Surgical prioritization based on decision model outcomes is not sensitive to differences between the health-related quality of life values estimates of physicians and citizens

“…In the previous study evaluating physicians’ HRQoL valuation, 15 physicians participated (the PP), 8 of whom were from surgical specialties. Detailed information regarding the composition of this panel can be found in our earlier publication [ 16 ].…”

“…In our previous studies, physicians had estimated HRQoL values for 43 semi-elective surgeries frequently performed in academic hospitals [ 14 , 16 ]. For each surgery, the health loss, expressed as disability-adjusted life years (DALY) per month of surgical delay, was calculated.…”

“…For each surgery, we established a description of the pre- and post-operative health states, the so-called “vignettes”, for use with our citizen panel. These were derived from vignettes used in earlier studies [ 14 , 16 ]. In live panel sessions, experienced physicians described health states of typical patients, while others asked clarifying questions [ 14 ].…”

“…In live panel sessions, experienced physicians described health states of typical patients, while others asked clarifying questions [ 14 ]. These vignettes were documented and reused in the follow-up study after a collective review with our research group [ 16 ]. In the current study, these vignettes were again employed.…”

“…We aimed for 15–20 citizens per panel as this is within the typical range of other Delphi studies [ 18 , 19 ]. To obtain HRQoL values from physicians, we used data from our previously published studies [ 16 ]. This physician panel was purposefully chosen because they had previously valued the same health states using the same method, which will be discussed below.…”