Health Economics Scenario Lab
WaitWise
Explore how waiting list interventions might reduce backlog pressure, escalations, admissions, bed use, and economic burden under different assumptions.
Scope and use note
WaitWise is an exploratory scenario sandbox. It is designed to test how changes in targeting, demand, throughput, escalation risk, persistence, and delivery cost might influence potential operational and economic value. It does not replace formal evaluation, forecasting, or business case development.
Signal
Above current threshold
Discounted net cost
£1,108,359
Cost/QALY
£37,871
Headline view
Start with the current decision signal and the main economic outputs.
Waiting list reduction
1,887
Escalations avoided
378
Discounted net cost
£1,108,359
Discounted cost per QALY
£37,871
Return on spend
0.34x
Max intervention cost per patient
£104
Required intervention effect
17.3%
Current case type
Broad waiting-list case
What this suggests
WaitWise suggests the intervention delivers measurable benefit over 3 years, but the discounted economic case remains above the current threshold.
Main dependency
escalation reduction while waiting
Main fragility
The case looks fragile: some bounded cases are below threshold, while others are not.
Charts
Primary chart first, with supporting views below.
Cost vs savings
Cumulative programme cost compared with cumulative gross savings.
Assumptions
Start from the default case, then adjust the key inputs and advanced settings.
Quick assumptions
Core setup
Share of the list effectively reached.
Targeting approach
Set how concentrated the intervention is by adjusting the size of the target group, likely reach within that group, and their relative escalation risk.
Share of the total waiting list considered in scope.
Relative reach within the targeted subgroup.
Relative escalation risk in the targeted subgroup.
Intervention effects
These are the main levers shaping where value comes from.
Lowers new demand entering the list.
Raises the number of patients processed.
Reduces deterioration while patients wait.
Analysis
Review the current case, uncertainty, sensitivity, and practical next checks.
Report export
Export a structured summary of the current assumptions, results, and interpretation.
Strategic summary
Over 3 years, WaitWise suggests the intervention creates measurable operational benefit, with around 1887 fewer people on the waiting list and 94 admissions avoided, but the discounted economic case remains above the current threshold. The current case uses escalation and admission savings only. The result is most strongly shaped by escalation reduction while waiting. The case looks fragile: some bounded cases are below threshold, while others are not.
Current case type
Broad waiting-list case
Return on spend
0.34x
Break-even horizon
>10 years
Recommendation summary
What this suggests
WaitWise suggests the intervention delivers measurable benefit over 3 years, but the discounted economic case remains above the current threshold.
What is driving it
escalation reduction while waiting
What looks fragile
The case looks fragile: some bounded cases are below threshold, while others are not.
Validate next
Validate the highest-leverage assumptions locally, especially intervention effect, escalation risk, and delivery cost.
Uncertainty readout
Low
£83,347
1,495 waiting list reduction · Above current threshold
Base
£37,871
1,887 waiting list reduction · Above current threshold
High
£15,559
2,286 waiting list reduction · Appears cost-effective
Top sensitivity drivers
Driver 1
escalation reduction effect
Largest ICER swing: £23,983
Driver 2
monthly escalation rate
Largest ICER swing: £23,983
Driver 3
intervention cost per patient reached
Largest ICER swing: £23,023
Confidence readout
This sandbox combines operational assumptions, illustrative intervention effects, and user-defined targeting multipliers. The most decision-relevant next step is to validate local reach, subgroup concentration, escalation risk, and delivery cost.
Headline view
Start with the current decision signal and the main economic outputs.
Waiting list reduction
1,887
Escalations avoided
378
Discounted net cost
£1,108,359
Discounted cost per QALY
£37,871
Return on spend
0.34x
Max intervention cost per patient
£104
Required intervention effect
17.3%
Current case type
Broad waiting-list case
What this suggests
WaitWise suggests the intervention delivers measurable benefit over 3 years, but the discounted economic case remains above the current threshold.
Main dependency
escalation reduction while waiting
Main fragility
The case looks fragile: some bounded cases are below threshold, while others are not.
Charts
Primary chart first, with supporting views below.
Cost vs savings
Cumulative programme cost compared with cumulative gross savings.
Backlog reduction
Annual waiting list reduction across the selected horizon.
Pathway impact
Headline pathway changes over the selected horizon.
Bounded uncertainty
Low, base, and high cases against the current threshold.
One-way sensitivity
Top drivers of discounted cost per QALY when varied one at a time.
Assumptions
Start from the default case, then adjust the key inputs and advanced settings.
Quick assumptions
Core setup
Share of the list effectively reached.
Targeting approach
Set how concentrated the intervention is by adjusting the size of the target group, likely reach within that group, and their relative escalation risk.
Share of the total waiting list considered in scope.
Relative reach within the targeted subgroup.
Relative escalation risk in the targeted subgroup.
Intervention effects
These are the main levers shaping where value comes from.
Lowers new demand entering the list.
Raises the number of patients processed.
Reduces deterioration while patients wait.
Advanced assumptions
Analysis
Review the current case, uncertainty, sensitivity, and validation prompts.
Report export
Export a structured summary of the current assumptions, results, and interpretation.
Strategic summary
Over 3 years, WaitWise suggests the intervention creates measurable operational benefit, with around 1887 fewer people on the waiting list and 94 admissions avoided, but the discounted economic case remains above the current threshold. The current case uses escalation and admission savings only. The result is most strongly shaped by escalation reduction while waiting. The case looks fragile: some bounded cases are below threshold, while others are not.
Current case type
Broad waiting-list case
Admissions avoided
94
Bed days avoided
378
Return on spend
0.34x
Recommendation summary
What this suggests
WaitWise suggests the intervention delivers measurable benefit over 3 years, but the discounted economic case remains above the current threshold.
What is driving it
escalation reduction while waiting
What looks fragile
The case looks fragile: some bounded cases are below threshold, while others are not.
Validate next
Validate the highest-leverage assumptions locally, especially intervention effect, escalation risk, and delivery cost.
Uncertainty readout
Low
£83,347
1,495 waiting list reduction · Above current threshold
Base
£37,871
1,887 waiting list reduction · Above current threshold
High
£15,559
2,286 waiting list reduction · Appears cost-effective
Sensitivity
One-way sensitivity
Top drivers of discounted cost per QALY when varied one at a time.
Driver 1
escalation reduction effect
Largest ICER swing: £23,983
Driver 2
monthly escalation rate
Largest ICER swing: £23,983
Driver 3
intervention cost per patient reached
Largest ICER swing: £23,023
Decision readout
Current case type
Broad waiting-list case
Uncertainty readout
The case looks fragile: some bounded cases are below threshold, while others are not.
Interpretation summary
WaitWise suggests the intervention delivers measurable benefit over 3 years, but the discounted economic case remains above the current threshold.
Confidence readout
Treat the result as exploratory until local subgroup concentration, reach, escalation risk, and delivery cost are validated.
Assumption review
Starting waiting list
8,000
Baseline backlog size.
Monthly inflow
900
New demand entering the list each month.
Baseline throughput
800
Patients processed per month before intervention.
Average wait duration
5.0 months
Contextual wait duration proxy.
Intervention reach
40.0%
Share of the list effectively reached.
Target population multiplier
100.0%
Relative size of the subgroup in scope.
Target reach multiplier
1.00x
Relative reach inside the targeted subgroup.
Target escalation risk multiplier
1.00x
Relative escalation risk in the subgroup.
Demand reduction effect
8.0%
Reduction in inflow.
Throughput increase effect
10.0%
Improvement in processing capacity.
Escalation reduction effect
12.0%
Reduction in deterioration while waiting.
Intervention cost per patient
£180
Main programme cost lever.
Annual effect decay
10.0%
How quickly intervention effect weakens.
Annual participation drop-off
5.0%
How quickly effective reach falls.
Monthly escalation rate
3.0%
Baseline deterioration risk while waiting.
Admission rate after escalation
25.0%
Escalations translating into admissions.
Average length of stay
4.0 days
Used to derive bed days avoided.
QALY gain per escalation avoided
0.08
Health gain assumption.
Cost per escalation
£700
Unit cost of escalation.
Cost per admission
£3,500
Unit cost of admission.
Cost per bed day
£400
Illustrative bed-day value.
Costing method
Escalation and admission savings only
Economic framing used in the model.
Time horizon
3 years
Duration of the scenario.
Discount rate
3.5%
Present-value adjustment.
Cost-effectiveness threshold
£20,000
Threshold used to interpret cost per QALY.