Cost-utility analysis of private contracting to reduce public waiting times for joint replacement surgery

Jonathan Karnon, Bahareh Mesgarian Haghighi, Babu Sajjad, Sokunthea Yem, Anuji Gamage, Aaron Thorpe

Research output: Contribution to journalArticlepeer-review

2 Citations (Scopus)


Objectives: Earlier treatment of publicly funded patients may achieve health gains that justify the additional costs of reducing waiting times. This study reports on the cost-effectiveness of implementing a private contracting model to meet alternative maximum waiting time targets for publicly funded patients undergoing total knee replacement surgery in Australia.

Methods: A linked decision tree and cohort Markov model was developed and populated and validated using secondary data sources to represent the pathways, costs, and quality adjusted life-years (QALYs) gained of non-urgent patients with alternative waiting times for total knee replacement surgery to a maximum age of 100 years.

Results: Assuming public waiting times are reduced through the purchase of private services, additional QALYs are gained at an incremental cost of less than $40,000. Value could be increased if lower private prices could be negotiated. Results are also sensitive to the rate of deterioration in function while waiting for surgery and the impact of functional status at the time of surgery on postsurgery outcomes.

Conclusions: More evidence on the value of expanded capacity or new models of care may inform new funding models to support such investments and reduced prices for new technologies, leading to more efficient and sustainable publicly funded healthcare systems.

Original languageEnglish
Pages (from-to)147-155
Number of pages9
JournalInternational Journal of Technology Assessment in Health Care
Issue number2
Publication statusPublished - 1 Jan 2018
Externally publishedYes


  • Economic evaluation
  • Elective surgery
  • Markov model
  • Quality-Adjusted life-years
  • Total knee replacement


Dive into the research topics of 'Cost-utility analysis of private contracting to reduce public waiting times for joint replacement surgery'. Together they form a unique fingerprint.

Cite this