Quality-adjusted life years and surgical waiting list: Systematic review of the literature

Table 1 Surgical specialties in which quality-adjusted life years have been used in surgical waiting lists and the procedures evaluated

Surgical specialties	Articles, n	Procedure evaluated and references
General surgery	15	Bariatric surgery (n = 1)[25]
		Liver transplant (n = 14)[10,13,14,16,17,31-39]
Urology	15	Kidney transplant (n = 15)[11,18,40-52]
Heart surgery	5	Heart transplant (n = 4)[7-9,53]
		Transcatheter aortic valve implantation (n = 1)[28]
Thoracic surgery	4	Lung transplant (n = 4)[15,54-56]
Traumatology	4	Total knee arthroplasty (n = 3)[20-22]
		Mosaicplasty (n = 1)[27]
Pediatric surgery	2	Heart transplant (n = 1)[57]
		Intestinal transplant (n = 1)[58]
Ophthalmology	2	Cataract surgery (n = 2)[23,24]
Otorhinolaryngology	1	Septoplasty (n = 1)[26]

Table 2 Types of models used to measure quality-adjusted life years

Models used	Articles, n	Type of study[references]	Articles, n
Real-life	9
		Retrospective cohort[27]	1
		Randomized controlled trial[24]	1
		Historical and concurrent cohort[54]	1
		Prospective randomized study[21]	1
		Not specified[24,31,33,55,56]	5
Theoretical	39
		Markov model[9-11,13-18,20,22,23,25,28,32,34-40,42-45,47-52,57,58]	34
		Double Queueing Model[41]	1
		Not specified[7,8,46,53]	4

Table 3 Models and surveys used to measure quality-adjusted life years

Models used	Surveys used[references]	Articles, n
Real-life	15-D instrument[21,31]	2
	EQ-5D[24,26,27,33,55,56]	6
	Not specified[54]	1
Theoretical	EQ-5D[10,25,28,36,46]	5
	SF-LDQoL questionnaire[39]	1
	SF-36[15]	1
	WOMAC[20]	1
	Not specified[7-9,11,13,14,16-18,22,23,32,34,35,37,38,40-45,47-53,57,58]	31

15-D instrument: 15 dimensional; EQ-5D: European quality of life-5 dimensions; SF-36: Short form 36 health survey questionnaire; SF-LDQoL: Short form-liver disease quality of life; WOMAC: The Western Ontario and McMaster Universities Arthritis Index.

Table 4 Countries where the study was carried out, and the economic value of the quality-adjusted life years

Country	Articles, n[references]	Economic value of the QALY (n = 24)
United States	21[7-10,13,16,22,34,37,38,40-44,47,49-51,53,57]	WTP $50000 to $100000/QALY[7-10,13,22,53,57]
United Kingdom	9[14,15,24,26,27,33,39,46,56]	WTP £20000 to £30000/QALY[14,15,24,26,27,33]
Finland	2[21,31]	Not specified
Spain	1[28]	WTP 20000 to 25000€/QALY[28]
Italy and United States	1[35]	WTP $50000/QALY[35]
Norway	1[32]	WTP 70500€/QALY[32]
Portugal	1[55]	WTP 50000€/QALY[55]
Sweden	1[25]	WTP < €35500/QALY[25]
Switzerland	1[17]	WTP €35000/QALY[17]

QALY: Quality-adjusted life years; WTP: Willingness to pay.

Table 5 Summary of study objectives

Aim	Articles, n[references]
To determine whether a specific surgical procedure was cost-effective in a certain disease or dependent on certain characteristics of the cohort in which it was performed	14[21-26,28,31-33,41,54,55,58]
To determine whether increasing the pool of organs through various strategies was cost-effective	26[8-11,13-18,20,34,36-41,46-52,57]
To compare either two surgical procedures, a surgical procedure vs standard treatment, bridging treatment while on the waitlist, or an alternative treatment in order to determine which had better outcomes in terms of cost-effectiveness	8[27,35,42-45,53,56]