Cataract surgery for falls prevention and improving vision: modelling the health gain, health system costs and cost-effectiveness in a high-income country

Abstract

AimTo estimate the health gain, health system costs and cost-effectiveness of cataract surgery when expedited as a falls prevention strategy (reducing the waiting time for surgery by 12 months) and as a routine procedure.MethodsAn established injurious falls model designed for the New Zealand (NZ) population (aged 65+ years) was adapted. Key parameters relating to cataracts were sourced from the literature and the NZ Ministry of Health. A health system perspective with discounting at 3% was used.ResultsExpedited cataract surgery for 1 year of incident cases was found to generate a total 240 quality-adjusted life years (QALYs) (95% uncertainty interval (UI) 161 to 360) at net health system costs of NZ$2.43 million (95% UI 2.02 to 2.82 million) over the remaining lifetimes of the surgery group. This intervention was cost-effective by widely accepted standards with an incremental cost-effectiveness ratio (ICER) of NZ$10 600 (US$7540) (95% UI NZ$6030 to NZ$15 700) per QALY gained. The level of cost-effectiveness did not vary greatly by sex, ethnicity and previous fall history, but was higher for the 65–69 age group compared with the oldest age group of 85–89 years (NZ$7000 vs NZ$14 200 per QALY gained). Comparing cataract surgery with no surgery, the ICER was even more favourable at NZ$4380 (95% UI 2410 to 7210) per QALY. Considering only the benefits for vision improvement and excluding the benefits of falls prevention, it was still favourable at NZ$9870 per QALY.ConclusionsExpedited cataract surgery appears very cost-effective. Routine cataract surgery is itself very cost-effective, and its value appears largely driven by the falls prevention benefits.

Economic Models of Community-Based Falls Prevention: A Systematic Review With Subsequent Commissioning And Methodological Recommendations

“…Most models (n=25; 52.2%) targeted a general population of community-dwelling adults aged 60+ or 65+; two targeted women only [47,48]. Two models targeted general adult populations aged 65+ which would contain a minority of institutionalised adults [49,50]; two incorporated institutionalisation as a non-nal model state [51,52]. Five targeted populations with falls history [53][54][55][56][57] There were four types of economic analysis: cost-effectiveness analysis (CEA), cost-bene t analysis, (CBA), return-on-investment analysis (ROI), and CUA.…”

“…The lowest scored item across models was item 15, which recommends reporting total/all-cause health resource utilisation costs under base case analysis and fall-related costs under sensitivity analysis. For this, only four models (all using primary collection of cost data) incorporated all-cause healthcare costs as the main economic outcome [58, 66, 67, 76]; six incorporated comorbidity care costs, which together with fall-related costs constitute all-cause costs [49,52,71,80,87,90]. The second lowest scored item was item 21, which recommends: (i) reporting intervention costs and all-cause/fall-related healthcare costs separately; and (ii) reporting both aggregate and mean costs.…”

“…Studies noted the technical di culty in costing LTC admission, particularly in identifying admissions directly attributable to falls and in stratifying costs by age and life expectancy at admission[53, 78, 80].Four models incorporated all-cause ('AC'), rather than fall-speci c, care consequences using primary data from intervention studies [58, 66, 67, 76]. Six models incorporated comorbidity care costs[49,52,71, 80, 87,90]. The four BODE3 models incorporated annual (all-cause) healthcare cost and cost of dying that varied by age and sex; falls prevention indirectly affected these costs by changing the life expectancy and age at death via fatal fall prevention Johansson (2008).…”

“…categorises all model-evaluated interventions by access pathway -reactive, proactive, self-referred or unclear -and intervention type. Of 101 interventions in total -counting multiple forms per study separately -nearly half(49) had unclear pathway descriptions. The most common pathway was proactive with 29 interventions, followed by self-referred (16) and reactive(7).…”

The Association between Socioeconomic Factors and Visual Function among Patients with Age-Related Cataracts

“…Therefore, the increase in the cataract surgery rate is probably due to the increasing demand for visual function and quality of life combined with the increasing incidence of cataracts, rather than solely for an increasing incidence of cataracts [ 24 ]. Cataracts are a huge economic burden [ 25 ], and cataract surgery is cost-effective and can probably promote economic development [ 26 – 29 ]. Therefore, a vicious cycle may exist where deprivation decreases the cataract surgery rate, and this low cataract surgery rate makes it hard for an individual or region to be lifted out of poverty.…”