title: Second-eye cataract surgery in elderly women: a cost-utility analysis conducted alongside a randomized controlled trial.
abstract: OBJECTIVE
  The aim of this study was to evaluate the cost-effectiveness of second-eye cataract surgery for older women with minimal visual dysfunction in the eye to be operated on from a Health and Personal Social Services perspective, compared to waiting list controls who had already undergone first-eye cataract surgery.
  
  
  METHODS
  A cost-utility analysis was undertaken alongside a randomized controlled trial of second-eye cataract surgery in secondary care ophthalmology clinics. A total of 239 women over 70 years old with one unoperated cataract were randomized to cataract surgery (expedited, approximately 4 weeks) or control (routine surgery, 12 months wait). Outcomes were measured in terms of quality-adjusted life years (QALYs), with health-related quality of life estimated using the EuroQol EQ-5D.
  
  
  RESULTS
  The operated group had costs which were, on average, pound646 more than the control group (95% confidence interval, pound16-1276, P<0.04) and had a mean QALY gain of 0.015 (95% confidence interval, -0.039 to 0.068, P=0.59) per patient over 1 year. Therefore, the incremental cost-utility ratio was pound44,263 over the 1-year trial period. In an analysis modelling costs and benefits over patients' expected lifetime, the incremental cost per QALY was pound17,299, under conservative assumptions.
  
  
  CONCLUSIONS
  Second-eye cataract surgery is not likely to be cost-effective in the short term for those with mild visual dysfunction pre-operation. In the long term, second-eye cataract surgery appears to be cost-effective unless carer costs are included.
authors.affiliation: School of Chemical Sciences and Pharmacy, University of East Anglia, Norwich, UK. T.Sach@uea.ac.uk
authors.forename: T H
authors.initials: TH
authors.lastname: Sach
authors.forename: A J E
authors.initials: AJ
authors.lastname: Foss
authors.forename: R M
authors.initials: RM
authors.lastname: Gregson
authors.forename: A
authors.initials: A
authors.lastname: Zaman
authors.forename: F
authors.initials: F
authors.lastname: Osborn
authors.forename: T
authors.initials: T
authors.lastname: Masud
authors.forename: R H
authors.initials: RH
authors.lastname: Harwood
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002386:Cataract / Q000191:economics*; D002387:Cataract Extraction / Q000191:economics*; D003362:Cost-Benefit Analysis; D005260:Female; D017048:Health Care Costs; D006801:Humans; D018803:Models, Economic; D017063:Outcome Assessment, Health Care; D019057:Quality-Adjusted Life Years