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

• Published in: Canadian Journal of Surgery 2016-04, Vol.59 (2), p.107-112
• Main Authors: O’Hara, Nathan N., MHA, Slobogean, Gerard P., MD, MPH, Mohammadi, Tima, MSc, Marra, Carlo A., PharmD, PhD, Vicente, Milena R., RN, CCRP, McKee, Michael D., MD, Khakban, Amir, MSc
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Arthroplasty; Arthroplasty, Replacement - economics; Canada; Choice Behavior; Clinical Competence; Economic aspects; Evaluation; Female; Forecasts and trends; Health attitudes; Health Expenditures; Health Services Accessibility; Hospital costs; Humans; Joint surgery; Logistic Models; Male; Medical care, Cost of; Medical treatment; Middle Aged; Osteoarthritis - psychology; Osteoarthritis - surgery; Patient Preference; Patients; Preferences; Shoulder Joint; Studies; Surgery; Surveys and Questionnaires; Waiting Lists
• ISSN: 0008-428X; 1488-2310
• DOI: 10.1503/cjs.011915

Background Total shoulder arthroplasty (TSA) is a common treatment to decrease pain and improve shoulder function in patients with severe osteoarthritis (OA). In Canada, patients requiring this procedure often wait a year or more. Our objective was to determine patient preferences related to accessing TSA, specifically comparing out-of-pocket payments for treatment, travel time to hospital, the surgeon’s level of experience and wait times. Methods We administered a discrete choice experiment among patients with end-stage shoulder OA currently waiting for TSA. Respondents were presented with 14 different choice sets, each with 3 options, and they were asked to choose their preferred scenario. A conditional logit regression model was used to estimate the relative preference and willingness to pay for each attribute. Results Sixty-two respondents completed the questionnaire. Three of the 4 attributes significantly influenced treatment preferences. Respondents had a strong preference for an experienced surgeon (mean 0.89 ± standard error [SE] 0.11), while reductions in travel time (−0.07 ± 0.04) or wait time (−0.04 ± 0.01) were of less importance. Respondents were found to be strongly averse (−1.44 ± 0.18) to surgical treatment by a less experienced surgeon and to paying out-of-pocket for their surgical treatment (−0.56 ± 0.05). Conclusion Our results suggest that patients waiting for TSA to treat severe shoulder OA have minimal willingness to pay for a reduction in wait time or travel time for surgery, yet will pay higher amounts for treatment by an experienced surgeon.