Cost-utility of routine cataract surgery.
BACKGROUND
If 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.


METHODS
Prospective 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.


RESULTS
Mean (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 euro5128 for patients whose both eyes were operated and euro8212 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.


CONCLUSIONS
Mean 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.
Räsänen
Pirjo
P
Helsinki and Uusimaa Hospital Group, Group Administration, P,O,Box 440, 00029 HUS, Helsinki, Finland. pirjo.rasanen@stakes.fi
Krootila
Kari
K
Sintonen
Harri
H
Leivo
Tiina
T
Koivisto
Anna-Maija
AM
Ryynänen
Olli-Pekka
OP
Blom
Marja
M
Roine
Risto P
RP
D000368:Aged; D000369:Aged, 80 and over; D002387:Cataract Extraction / Q000191:economics* / Q000523:psychology / Q000706:statistics & numerical data; D003362:Cost-Benefit Analysis; D005260:Female; D005387:Finland; D017721:Hospital Costs; D006782:Hospitals, Special / Q000191:economics*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009885:Ophthalmology / Q000191:economics; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data; D011446:Prospective Studies; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D011795:Surveys and Questionnaires; D035501:Uncertainty; D014792:Visual Acuity