title: Is cataract surgery cost-effective among older patients with a low predicted probability for improvement in reported visual functioning?
abstract: BACKGROUND
  Although cataract surgery has been demonstrated to be effective and cost-effective, 5% to 20% of patients do not benefit functionally from the procedure. This study examines the cost-effectiveness of cataract surgery versus watchful waiting in a subgroup of patients who had less than a 30% predicted probability of reporting improvements in visual function after surgery.
  
  
  METHODS
  Randomized trial (first eye surgery vs. watchful waiting) of 250 patients who based on a cataract surgery index (CSI) were felt to have less than a 30% probability of reporting improvements in visual functioning after surgery. Cost was estimated using monthly resource utilization surveys and Medicare billing and payment data. Effectiveness was evaluated at 6 months using the Activities of Daily Vision Scale (ADVS) and the Health Utilities Index, Mark 3 (HUI3).
  
  
  RESULTS
  In terms of overall utility, the incremental cost-effectiveness of surgery was Dollars 38,288/QALY. In the subgroup of patients with a CSI score > 11 (< 20% probability of improvement), the cost-effectiveness of cataract surgery was Dollars 53,500/QALY. Sensitivity analysis demonstrated that often this population of patients may not derive a utility benefit with surgery.
  
  
  CONCLUSIONS
  Cataract surgery is cost-effective even in a subpopulation of patient with a lower, < 30%, predicted probability of reporting improved visual functioning after surgery. There may be a subgroup of patients, CSI > 11, for whom a strategy of watchful waiting may be equally effective and considerably less expensive.
authors.affiliation: Division of Hematology-Oncology, UCLA Department of Medicine, Los Angeles, California 90095-1687, USA. anaeim@mednet.ucla.edu.cpy
authors.forename: Arash
authors.initials: A
authors.lastname: Naeim
authors.forename: Emmett B
authors.initials: EB
authors.lastname: Keeler
authors.forename: Peter R
authors.initials: PR
authors.lastname: Gutierrez
authors.forename: M Roy
authors.initials: MR
authors.lastname: Wilson
authors.forename: David
authors.initials: D
authors.lastname: Reuben
authors.forename: Carol M
authors.initials: CM
authors.lastname: Mangione
mesh_terms: D000203:Activities of Daily Living; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D002387:Cataract Extraction / Q000191:economics*; D003362:Cost-Benefit Analysis; D003627:Data Interpretation, Statistical; D003953:Diagnosis-Related Groups; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D006278:Medicare / Q000191:economics; D015999:Multivariate Analysis; D012044:Regression Analysis; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome; D014787:Vision Tests; D014785:Vision, Ocular / Q000502:physiology*; D014792:Visual Acuity / Q000502:physiology