Cost and Expected Visual Effect of Interventions to Improve Follow-up After Cataract Surgery

Abstract

IMPORTANCE Some experts recommend increasing low rates of follow-up after cataract surgery in low-and middle-income countries using various interventions. However, little is known about the cost and effect of such interventions.OBJECTIVE To examine whether promoting follow-up after cataract surgery creates economic value. DESIGN, SETTING, AND PARTICIPANTSThe Prospective Review of Early Cataract Outcomes and Grading (PRECOG) is a cohort study with data from patients undergoing cataract surgery from January 19, 2010, to April 18, 2012. Final follow-up was completed on August 10, 2012. Data were collected before surgery, at discharge, and at follow-up at least 40 days after surgery from 27 centers in 8 countries in Asia, Africa, and Latin America. Each center enrolled 40 to 120 consecutive patients undergoing cataract surgery. If patients did not return to the hospital for the follow-up visit, hospitals could use telephone calls or transportation subsidies to increase follow-up rate. Data were analyzed from December 2013 to January 2016. MAIN OUTCOMES AND MEASURES Cost of interventions (telephone calls and transportationsubsidies) to increase follow-up at least 40 days after surgery, visual acuity (VA) in the eye undergoing cataract surgery, presence of complications, patient and facility costs per visit, and willingness to pay for treatment or glasses if needed. The maximum incremental cost of improving VA in 1 patient (incremental cost-effect ratio [ICER]) was calculated for spontaneous follow-up (compared with no follow-up) and follow-up with the telephone and transportation interventions. Expected ICERs were estimated including only those patients willing to pay. RESULTS Among 2487 patients (1068 men [42.9%]; 1405 women [56.5%]; 14 missing [0.6%]; mean [SD] age, 68.4 [11.3] years), 2316 (93.1%) received follow-up, of whom 369 (16.0%) were seen in an outside facility or home and were in the cost-effectiveness analysis as unable to follow up. A grand mean (a mean of means of the different countries) of 56.3% of patients needed glasses, of whom 56.9% were willing to pay, and 1.6% had treatable complications, of whom 39.4% were willing to pay. Maximum proportions with improved VA (and corresponding ICERs) were 0.08 for no follow-up, 0.45 ($151.56) for spontaneous follow-up, 0.53 ($164.46) for a telephone intervention, and 0.53 ($133.07) for a transportation intervention. These results were most sensitive to the cost of follow-up. Expected proportions (ICERs) were 0.08, 0.27

Willingness-to-pay for spectacles studies: a scoping review of rationales and methodologies

“…It is possible, however, to remove hypothetical bias by a follow-up certainty question, which may result in realistic WTP [12]. While 13 studies in this scoping review were conducted in similar hypothetical conditions most did not report this shortcoming while others explicitly stated the overestimation and underestimation of WTP [28,33,34,45,50]. It is thus unclear whether these flaws were observed in any of the included studies.…”

Use of predictive models to identify patients who are likely to benefit from refraction at a follow-up visit after cataract surgery

“…The key outcome measure is a binary indicator of whether the patient will benefit from refraction at the follow-up visit, which we operationalize as a difference of two lines or more between uncorrected visual acuity (UCVA) and corrected distance visual acuity (CDVA) on the Snellen VA chart. [ 15 ] As predictors, we included all variables which are believed to have an association with VA after cataract surgery, and for which data were available in the database. Our approach to identifying and including potential predictors is consistent with our goal of developing predictive models, wherein a causal link between the predictor and outcome is not required.…”

“…For instance, Meltzer et al . (2015)[ 15 ] report that the estimated mean cost to a patient in India of a spontaneous follow-up visit, including round-trip transportation cost, food and living expenses, and loss of wages for the patient and accompanying persons, was $8.34. This implies that M = $ B /$ c patients can be targeted with the intervention.…”

New digital models of care in ophthalmology, during and beyond the COVID-19 pandemic

“…[10][11][12] Similarly, a large proportion of follow-up appointments (eg, stable cataract and glaucoma, postcataract surgery or stable retinal diseases) in many eye centres could be deferred and postponed. 13 Thus, during and after the COVID-19 pandemic, it is important to reduce non-urgent referrals and non-urgent follow-ups to eye centres. This will also reduce non-essential human movement in the community.…”