Minimizing Population Health Loss in Times of Scarce Surgical Capacity During the Coronavirus Disease 2019 Crisis and Beyond: A Modeling Study

Benjamin Gravesteijn, Eline Krijkamp*, Value Based Operation Room Triage team collaborators, Jan Busschbach, Geert Geleijnse, Isabel Retel Helmrich, Sophie Bruinsma, Céline van Lint, Ernest van Veen, Ewout Steyerberg, Cornelis Verhoef, Jan van Saase, Hester Lingsma, Rob Baatenburg de Jong

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

13 Citations (Scopus)
32 Downloads (Pure)


Objectives: Coronavirus disease 2019 has put unprecedented pressure on healthcare systems worldwide, leading to a reduction of the available healthcare capacity. Our objective was to develop a decision model to estimate the impact of postponing semielective surgical procedures on health, to support prioritization of care from a utilitarian perspective. Methods: A cohort state-transition model was developed and applied to 43 semielective nonpediatric surgical procedures commonly performed in academic hospitals. Scenarios of delaying surgery from 2 weeks were compared with delaying up to 1 year and no surgery at all. Model parameters were based on registries, scientific literature, and the World Health Organization Global Burden of Disease study. For each surgical procedure, the model estimated the average expected disability-adjusted life-years (DALYs) per month of delay. Results: Given the best available evidence, the 2 surgical procedures associated with most DALYs owing to delay were bypass surgery for Fontaine III/IV peripheral arterial disease (0.23 DALY/month, 95% confidence interval [CI]: 0.13-0.36) and transaortic valve implantation (0.15 DALY/month, 95% CI: 0.09-0.24). The 2 surgical procedures with the least DALYs were placing a shunt for dialysis (0.01, 95% CI: 0.005-0.01) and thyroid carcinoma resection (0.01, 95% CI: 0.01-0.02). Conclusion: Expected health loss owing to surgical delay can be objectively calculated with our decision model based on best available evidence, which can guide prioritization of surgical procedures to minimize population health loss in times of scarcity. The model results should be placed in the context of different ethical perspectives and combined with capacity management tools to facilitate large-scale implementation.

Original languageEnglish
Pages (from-to)648-657
Number of pages10
JournalValue in Health
Issue number5
Publication statusPublished - 1 May 2021

Bibliographical note

Funding/Support: Eline Krijkamp was supported by the Society for Medical Decision Making fellowship through a grant (GBMF7853) by the Gordon
and Betty Moore Foundation, Palo Alto, CA, United States. Support for this
study was solely from institutional and/or departmental sources.

Publisher Copyright: © 2021 ISPOR–The Professional Society for Health Economics and Outcomes Research


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