Cost efficiency and cost effectiveness of cataract surgery at the Malaysian Ministry of Health ophthalmic services.
OBJECTIVE
To determine the cost efficiency and to compare the cost effectiveness of conventional extracapsular cataract surgery (ECCE) and phacoemulsification at three hospitals of the Malaysian Ministry of Health (MOH).


METHODS
Patient demography, pre-operative visual acuity, intra-operative complications, post-operative complications and post-operative visual acuity were recorded for two hundred and forty seven of the 400 patients who underwent cataract surgery during a 2-week period. The cost of surgery, which included capital, staff and overhead, and patient care consumable costs were assessed prospectively in 8 randomly sampled patients over a 3-month period. Cost efficiency refers to cost per cataract surgery. Cost effectiveness refers to cost per successful cataract surgery. This is estimated by the ratio of cost efficiency to the proportion of successful cataract surgery. Successful surgery was defined as best-corrected visual acuity (BCVA) of better than 6/12 at 3 months post-operatively.


RESULTS
Proportion of patients who had post-operative visual acuity of 6/12 or better was higher in phacoemulsification group (94%) than in the ECCE group (81%). Conventional extracapsular cataract surgery with intraocular lens implant costs RM3442 (USD 905.79) and phacoemulsification with intraocular lens implant costs RM4288 (USD 1128.42).


CONCLUSIONS
There was no significant difference in cost effectiveness between ECCE and phacoemulsification. The cost of cataract surgery in the MOH hospital was found to be high due to the high overhead costs.
Department of Ophthalmology, Kuala Lumpur Hospital.
Cheen-Yeng
CY
Loo
Meena
M
Kandiah
Gomathy
G
Arumugam
Pik-Pin
PP
Goh
Elizabeth
E
John
Banu
B
Gurusami
T V
TV
Kumar
T V N
TV
Karunakar
Soraya
S
Azmi
Teck-Onn
TO
Lim
D000368:Aged; D002387:Cataract Extraction / Q000191:economics*; D003362:Cost-Benefit Analysis; D003365:Costs and Cost Analysis; D003695:Delivery of Health Care / Q000191:economics*; D005260:Female; D006077:Government Agencies; D017048:Health Care Costs; D006801:Humans; D008296:Malaysia; D008297:Male; D008875:Middle Aged; D009313:National Health Programs / Q000191:economics*