Falls and health status in elderly women following first eye cataract surgery: an economic evaluation conducted alongside a randomised controlled trial

Abstract

Aim: To evaluate the cost-effectiveness of first eye cataract surgery compared with no surgery from a health service and personal social services perspective. Methods: An economic evaluation undertaken alongside a randomised controlled trial of first eye cataract surgery in secondary care ophthalmology clinics. A sample of 306 women over 70 years old with bilateral cataracts was randomised to cataract surgery (expedited, approximately four weeks) or control (routine, 12 months wait); 75% of participants had baseline acuity of 6/12 or better. Outcomes included falls and the EuroQol EQ-5D. Results: The operated group cost a mean £2004 (bootstrapped) more than the control group over one year (95% confidence interval (CI), £1363 to £2833) (p,0.001), but experienced on average 0.456 fewer falls, an incremental cost per fall prevented of £4390. The bootstrapped mean gain in quality adjusted life years (QALYs) per patient was 0.056 (95% CI, 0.006 to 0.108) (p,0.001). The incremental cost-utility ratio was £35 704, above the currently accepted UK threshold level of willingness to pay per QALY of £30 000. However, in an analysis modelling costs and benefits over patients' expected lifetime, the incremental cost per QALY was £13 172, under conservative assumptions. Conclusions: First eye cataract surgery, while cost-ineffective over the trial period, was probably cost-effective over the participants' remaining lifetime.

Cost-effectiveness of a Home-Exercise Program Among Older People After Hospitalization

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Vision improvement and reduction in falls after expedited cataract surgery

“…25,[30][31][32][33] The 2 fall-related trials were included in this review 23,24 comprised women older than 70 years. The clinical literature suggests that when bones become thin and more fragile, they break more easily, causing injuries and severe disability.…”

Visual loss and falls: a review

“…However, in the same study the cost per QALY was calculated to be d13 172, when calculated for lifetime savings as opposed to over the time of the study. 75 Similar analyses of other promising interventions will aid assessment of their potential efficacy.…”