Modeling Health Effects of Alternative Treatment Options during Surgical Delay to Inform Prioritization of Surgical Care

ObjectivesTo estimate the health effects of temporarily substituting surgeries with alternative treatments to inform discussions on prioritization strategies during surgical capacity constraints.Study Setting and DesignThis study was conducted in the context of the Dutch health care system. We used a decision model to estimate the health effects of temporal substituting surgery with an alternative treatment option for 11 diseases. Model outcome was the number of disability-adjusted life-years (DALYs) associated with the alternative treatment during the waiting period for surgery. For each "disease-surgery" combination, the alternative treatment with the lowest DALYs was labeled the "best alternative." These "best alternatives" were ranked in descending order of DALYs, suggesting a prioritization of surgeries.Data Sources and Analytic SampleParameter values were obtained from registries, scientific literature, and expert consultations.Principal FindingsA total of 23 "disease-surgery-alternative treatment" combinations were evaluated. Substituting immediate pacemaker implantation with optimal medical therapy for symptomatic bradycardia results in the largest health loss per month, estimated at 0.13 DALYs (95% confidence interval [CI] 0.08 to 0.19). Replacing implantable cardioverter-defibrillator implantation with optimal medical therapy for ventricular arrhythmias results in the second-largest health loss of 0.08 DALYs per month delay (95% CI 0.05 to 0.10). In contrast, surgeries in which substitution with alternative treatments results in minimal health impact include radiation therapy instead of laser treatment for laryngeal cancer T1-2 (-0.01 DALY, 95% CI -0.02 to 0.00) and chemoradiation instead of surgical resection for laryngeal cancer T3-4 (-0.01 DALY, 95% CI -0.02 to 0.01).ConclusionsOur study facilitates the comparison of surgery and alternative treatment options across diseases and surgical disciplines and can contribute evidence-based discussions on prioritization among health care stakeholders.HighlightsThis study quantifies the health impact of substituting surgery with alternative treatments across 11 diseases using disability-adjusted life-years (DALYs).Some alternative treatments resulted in minimal or no health loss, while others were associated with substantial health detriment.The findings support evidence-based prioritization of surgical care by identifying where substitution is most and least harmful to patient outcomes.