Incremental cost-effectiveness of initial cataract surgery.
OBJECTIVE
The purpose of this study was to perform a reference case, cost-utility analysis of initial cataract surgery using the current literature on cataract outcomes and complications.


METHODS
Computer-based econometric modeling.


METHODS
Visual acuity data of patients treated and observed over a 4-month postoperative period was obtained from the US National Cataract Patient Outcomes Research Team (PORT). The results from this prospective study were combined with other studies that investigated the complication rates of cataract surgery to complete the cohort of patients and outcomes. These synthesized data were incorporated with time-tradeoff utility values, decision analysis, and econometric modeling to account for the time value of money.


METHODS
The number of quality-adjusted life-years (QALYs) gained was calculated for the study group undergoing cataract extraction in the first eye when the vision was the same in both eyes. This was divided into the cost of the procedure to find the year 2000 nominal US dollars spent per quality-adjusted life-year ($/QALY) gained.


RESULTS
Initial cataract surgery, compared with observation, resulted in a mean gain of 1.776 QALYs per patient treated. A 3% annual discount rate was used to account for the benefit over time, yielding 1.25 QALYs gained. The mean cost of treatment (also discounted at a 3% annual rate) of each patient totaled 2525 US dollars. The cost divided by the discounted benefit resulted in $2020/QALY gained for this procedure.


CONCLUSIONS
Initial cataract surgery seems to be highly cost-effective compared with procedures across multiple medical specialties. This information, incorporating patient preferences into evidenced-based medicine, will play an increasingly important role in the evaluation of health care in the future.
Busbee
Brandon G
BG
Center for Evidence-Based Health Care Economics, Wills Eye Hospital, Jefferson Medical College, Philadelphia, PA, USA.
Brown
Melissa M
MM
Brown
Gary C
GC
Sharma
Sanjay
S
D000368:Aged; D002387:Cataract Extraction / Q000191:economics*; D003362:Cost-Benefit Analysis; D003365:Costs and Cost Analysis; D017048:Health Care Costs; D006801:Humans; D019654:Lens Implantation, Intraocular / Q000191:economics; D017059:Models, Econometric; D017063:Outcome Assessment, Health Care; D019057:Quality-Adjusted Life Years; D014481:United States; D014792:Visual Acuity