Cost-utility of routine cataract surgery

Abstract

BackgroundIf decisions on health care spending are to be as rational and objective as possible, knowledge on cost-effectiveness of routine care is essential. Our aim, therefore, was to evaluate the cost-utility of routine cataract surgery in a real-world setting.MethodsProspective assessment of health-related quality of life (HRQoL) of patients undergoing cataract surgery. 219 patients (mean (SD) age 71 (11) years) entering cataract surgery (in 87 only first eye operated, in 73 both eyes operated, in 59 first eye had been operated earlier) filled in the 15D HRQoL questionnaire before and six months after operation. Direct hospital costs were obtained from a clinical patient administration database and cost-utility analysis performed from the perspective of the secondary care provider extrapolating benefits of surgery to the remaining statistical life-expectancy of the patients.ResultsMean (SD) utility score (on a 0–1 scale) increased statistically insignificantly from 0.82 (0.13) to 0.83 (0.14). Of the 15 dimensions of the HRQoL instrument, only seeing improved significantly after operation. Mean utility score improved statistically significantly only in patients reporting significant or major preoperative seeing problems. Of the subgroups, only those whose both eyes were operated during follow-up showed a statistically significant (p < 0.001) improvement. Cost per quality-adjusted life year (QALY) gained was €5128 for patients whose both eyes were operated and €8212 for patients with only one eye operated during the 6-month follow-up. In patients whose first eye had been operated earlier mean HRQoL deteriorated after surgery precluding the establishment of the cost per QALY.ConclusionMean utility gain after routine cataract surgery in a real-world setting was relatively small and confined mostly to patients whose both eyes were operated. The cost of cataract surgery per quality-adjusted life year gained was much higher than previously reported and associated with considerable uncertainty.

The Impact of Cataract Surgery on Health Related Quality of Life in Kenya, the Philippines, and Bangladesh

“…The lack of change has been attributed either to lack of sensitivity of the HRQoL instrument used or to a lack of importance of vision in the overall perception of health. 5,6 Neither of these interpretations are supported in the current study, where improvements in perception of health were observed using a brief and simple instrument (Euroqol). The severe levels of pre-operative bilateral vision loss, more common in low compared to high income settings, may partially explain this difference.…”

“…3 Other studies using the SF-36 instrument have found improvements in some, 9 but not all, domains. 6,32 In contrast, several studies have found no evidence of significant change in generic HRQoL, 4,5,33,34 including self-rated health 6 following cataract surgery. The lack of change has been attributed either to lack of sensitivity of the HRQoL instrument used or to a lack of importance of vision in the overall perception of health.…”

“…While a positive impact on VF and vision-related QoL (VRQoL) has been shown consistently in a range of settings, findings on generic HRQoL are mixed with some studies showing an improvement 2-3 and others finding no change. [4][5][6] In low-income settings, less is known. Studies in India have demonstrated improved VF and VRQoL after cataract surgery, but no information could be identified on the impact on generic HRQoL.…”

Cost-effectiveness of cataract surgery in Japan

“…Several previous studies have assessed the cost-utility of cataract surgery [8][9][10][11][12][13]. In the US, Busbee et al [8] reported that the costutility of first eye cataract surgery was $2,020/QALY and concluded that initial cataract surgery was highly costeffective when compared with procedures across multiple medical specialties.…”

Health‐related quality of life after cataract surgery with the phacoemulsification technique and intraocular lens implantation

“…Räsänen et al. () used the 15D instrument and reported an insignificant improvement in the mean 15D score, as only seeing of the 15 dimensions of the HRQoL instrument improved compared with baseline. Using the same generic instrument, 15D, we found slightly more improvement in the mean 15D score at 12 months with 0.018 in the present study versus 0.010 at 6 months after cataract surgery as found in the Räsänen et al.…”