The cost utility of strabismus surgery in adults.
OBJECTIVE
Cost-utility analysis evaluates the cost of medical care in relation to the gain in quality-adjusted life years (QALYs). Our purpose was to develop a cost model for surgical care for adult strabismus, to estimate the mean cost per case, to determine the associated gain in QALYs, and to perform cost-utility analysis.


METHODS
A cost model incorporated surgery, pre- and postoperative care, and a mean of 1.5 procedures per patient. The gain in QALYs was based on the improvement of utility on a scale from 0 (death) to 1 (perfect health). Utility was measured through physician-conducted interviews employing a time tradeoff question (seeking to estimate the portion of life expectancy a patient would be willing to trade for being rid of disease and associated effects). The interviews were conducted before and 5 to 8 weeks after surgery in 35 strabismic patients (age 19-75 years).


RESULTS
The cost model resulted in an estimated total cost of 4,254 dollars per case. A significant improvement of utility was found: 0.96 +/- 0.11 postoperatively versus 0.85 +/- 0.20 preoperatively (p = 0.00008). Based on the mean life expectancy (36.0 years) of these patients, and discounting outcomes and costs by 3% annually, this resulted in a mean value gain of 2.61 QALYs after surgery and a cost-utility for strabismus surgery of 1,632 dollas/QALY.


CONCLUSIONS
In the United States, treatments <50,000 dollars/QALY are generally considered "very cost-effective." Strabismus surgery in adults falls well within this range.
Beauchamp
Cynthia L
CL
Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, USA.
Beauchamp
George R
GR
Stager
David R
DR
Brown
Melissa M
MM
Brown
Gary C
GC
Felius
Joost
J
D000328:Adult; D000368:Aged; D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D005260:Female; D017048:Health Care Costs; D006302:Health Services Research / Q000191:economics; D006801:Humans; D008297:Male; D008875:Middle Aged; D018803:Models, Economic; D009801:Oculomotor Muscles / Q000601:surgery*; D013508:Ophthalmologic Surgical Procedures / Q000191:economics*; D011446:Prospective Studies; D019057:Quality-Adjusted Life Years; D013285:Strabismus / Q000191:economics* / Q000601:surgery*; D014481:United States