The hidden cost of patient feedback: analysis of a decade of NHS expenditure on orthopaedic PROMs

Patient-Reported Outcome Measures (PROMs) have become integral to assessing care quality, shifting emphasis from surgeon-centric metrics to patient-centred outcomes. Within the National Health Service (NHS) of the United Kingdom, routine PROMs collection for hip and knee arthroplasty has been mandated since 2009, but rising costs, falling completion rates, and operational inefficiencies raise concerns over sustainability. With completion rates for hip arthroplasty falling from 67% in 2014 to 27.6% in 2024, the financial cost for PROMs must be assessed. This study aimed to quantify the financial burden of PROMs collection across NHS orthopaedic services in England over the past decade and evaluate implications for policy, resource allocation, and digital transformation planning. A retrospective cost analysis was conducted of all NHS trusts in England listed on the National Joint Registry (NJR), excluding private providers. Freedom of Information (FOI) requests sought annual PROMs-related expenditure from 2015 to 2025, itemising internal staffing and third-party contractor costs. Trusts lacking complete cost breakdowns or exceeding FOI statutory work limits were excluded from total cost calculations but contributed to component-level analyses where possible. National costs were estimated using two extrapolation approaches (per-trust and per-procedure) and presented alongside sensitivity analyses. All trend analyses were performed using costs expressed in 2024 prices after adjustment for inflation with the Consumer Price Index (CPI); nominal costs are also reported to reflect actual NHS cash expenditure. Thirty-four trusts provided full data, representing 40.7% (41,293/101,525) of NHS arthroplasty procedures in England. After adjusting for CPI inflation, annual observed PROMs expenditure among these trusts rose from £1.144 million in 2015 to £1.39 million in 2024 with a real-terms increase of 21%, indicating that the majority of the nominal rise reflects inflationary pressures, though real cost growth persists. Modelled NHS-wide cumulative expenditure over ten years was estimated at between £29.1 million and £39.1 million, depending on extrapolation method. A total of 42 trusts provided third-party contracting costs. Contractor costs increased from a mean of £15,000 per trust in 2015 to £19,921 in 2024. Average trust internal staffing costs remained static averaging £32,068 in 2015 to £33,200 in 2024. PROMs are essential for patient-centred orthopaedic care but are associated with escalating costs, falling completion rates, and fragmented administration. Centralised procurement, NHS digital integration, dedicated staffing, and hybrid collection models are recommended to improve efficiency, data quality, and long-term sustainability. National expenditure estimates should be interpreted cautiously given the 32% response rate and reliance on modelling assumptions.