Cost-effectiveness analysis should continually assess competing health care options especially in high volume environments like cataract surgery

Abstract

Context:Cost-effectiveness analysis should continually assess competing health care options especially in high volume environments like cataract surgery.Aims:To compare the cost effectiveness of phacoemulsification (PE) versus manual small-incision cataract surgery (MSICS).Settings and Design:Prospective randomized controlled trial. Tertiary care hospital setting.Subjects and Methods:A total of 52 consenting patients with age-related cataracts, were prospectively recruited, and block randomized to PE or MSICS group. Preoperative and postoperative LogMAR visual acuity (VA), visual function-14 (VF-14) score and their quality-adjusted life years (QALYs) were obtained, and the change in their values calculated. These were divided by the total cost incurred in the surgery to calculate and compare the cost effectiveness and cost utility. Surgery duration was also compared.Statistical Analysis Used:Two group comparison with Student's t-test. Significance set at P < 0.05; 95% confidence interval (CI) quoted where appropriate.Results:Both the MSICS and PE groups achieved comparative outcomes in terms of change (difference in mean [95% CI]) in LogMAR VA (0.03 [−0.05−0.11]), VF-14 score (7.92 [−1.03−16.86]) and QALYs (1.14 [−0.89−3.16]). However, with significantly lower costs (INR 3228 [2700–3756]), MSICS was more cost effective, with superior cost utility value. MSICS was also significantly quicker (10.58 min [6.85–14.30]) than PE.Conclusions:MSICS provides comparable visual and QALY improvement, yet takes less time, and is significantly more cost-effective, compared with PE. Greater push and penetration of MSICS, by the government, is justifiably warranted in our country.

The Lancet Global Health Commission on Global Eye Health: vision beyond 2020

“…For cataract, we identified 11 publications providing 58 separate national or regional cost-effectiveness ratio estimates. 37 , 157 , 158 , 159 , 160 , 161 , 162 , 163 , 164 , 165 The average cost-effectiveness ratios are shown in figure 13 . The studies are heterogeneous in perspective, costs included, surgical procedure, and assumed duration of the health benefit, which limited our comparison.…”

“…In general, LMICs reported more favourable cost-effectiveness ratios for cataract surgery than did high-income countries. Two studies from India 158 and Nepal 160 showed that the cost-effectiveness ratio of a manual small-incision cataract surgery ranged from $5 to $95 per QALY gained and phacoemulsification surgery ranged from $47 to $142 per QALY gained. The highest estimate, from the UK, used a wider perspective, including personal social-care costs.…”

Development of a rapid point-of-care patient reported outcome measure for cataract surgery in India

“…Building on prior work in India [ 9 – 11 ], the current investigation describes the development of a brief and culturally relevant PRO measure that can be quickly administered at the point-of-care. Though further work could be done to improve the targeting of the SF-IND-VFQ, these features suggest that it may be a feasible tool to assess patient-reported visual function in a busy clinical practice.…”

“…Many patient-reported outcome (PRO) measures have been used to assess the impact of cataract on vision-related QOL and functioning [ 3 – 9 ] and a number of these have been employed among Indian patients undergoing cataract surgery [ 8 – 11 ]. However, existing instruments may not be culturally relevant to patients in India [ 3 , 4 ]; have not been adequately validated [ 9 ]; or are too lengthy to be deployed as point-of-care tests in a high-volume clinical setting [ 7 ].…”

Burning bright or burning out?

“…This issue also carries an article on a highly debated topic – comparison of cost effectiveness of small incision cataract surgery versus phacoemulsification and the quality-adjusted life years of subjects. This article by Dr. Amitava et al [ 6 ] studies a sample of 52 subjects.…”