Phacoemulsification versus extracapsular extraction: governmental costs.
To evaluate the governmental costs of patients undergoing phacoemulsification and extracapsular cataract extraction at a public hospital in a developing country.



A prospective study was conduced with 205 patients. The subjects were randomized for cataract surgery using either phacoemulsification or extracapsular cataract extraction techniques.



Of the 205 patients, 101 patients were submitted to phacoemulsificationand 104 patients were submitted to extracapsular cataract extraction. Brazilian Health Care System expenditures for the surgery and the postoperative period were US$ 95.49 more in the phacoemulsification group than in the extracapsular cataract extractiongroup. If we take into account Social Security expenditures, then we estimate that the average difference for the total direct cost for the government for the surgery and the postoperative period for both procedures was US$ 50.91 or approximately half of the initial difference in cost for the phacoemulsification surgery. The total cost of cataract surgery for the government (excluding social security) was estimated at US$ 258.79 for extracapsular cataract extraction and US$ 309.70 for phacoemulsification per patient. Focusing only on working patients, the total cost was US$ 342.21 for phacoemulsification and US$ 587.71 for extracapsular cataract extraction, a difference of US$ 245.50. This difference can be considered monetarily and socially justifiable when the benefits of the surgical technique are evaluated.



Under the conditions of this study, we observed that phacoemulsification was an efficient procedure with regard to the impact on public health care system, when all costs are assessed comprehensively, mainly for subjects with regular jobs.
Kara
Newton
N
Ophthalmology Department, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil. maysa_mazurek@hotmail.com
Sirtoli
Maysa Godoy Gomes Mazurek
MG
Santhiago
Marcony Rodrigues
MR
Parede
Tais Renata Ribeira
TR
Espíndola
Rodrigo França de
RF
Carvalho
Regina de Souza
Rde S
D000368:Aged; D000369:Aged, 80 and over; D001938:Brazil; D002387:Cataract Extraction / Q000191:economics* / Q000379:methods / Q000706:statistics & numerical data; D003906:Developing Countries; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D018918:Phacoemulsification / Q000191:economics / Q000706:statistics & numerical data; D011446:Prospective Studies; D018709:Statistics, Nonparametric
Clinics (Sao Paulo). 2009;64(4):309-12
19488587
Curr Opin Ophthalmol. 2005 Jun;16(3):191-4
15870578
Br J Ophthalmol. 2001 Jul;85(7):765-6
11423441
Acta Ophthalmol Scand. 2002 Jun;80(3):248-57
12059861
Br J Ophthalmol. 2001 Jul;85(7):822-9
11423457
Eur J Ophthalmol. 1996 Jul-Sep;6(3):257-63
8908430
Br J Ophthalmol. 1998 May;82(5):469-71
9713049
Ophthalmic Epidemiol. 2004 Dec;11(5):369-80
15590584
Ophthalmology. 2007 May;114(5):965-8
17296230
Ophthalmologica. 1997;211(1):8-12
8958525
Arch Ophthalmol. 1990 Jun;108(6):797-8
2350281
Clinics (Sao Paulo). 2009;64(7):637-40
19606238
Eye (Lond). 1992;6 ( Pt 6):626-9
1289142
J Cataract Refract Surg. 1999 Jun;25(6):851-9
10374168
J Cataract Refract Surg. 1996 Jul-Aug;22(6):717-20
8844384
Arq Bras Oftalmol. 2005 May-Jun;68(3):357-62
16059568
Doc Ophthalmol. 1992;82(1-2):1-7
1305012
J Cataract Refract Surg. 1996 Oct;22(8):1108-12
8915808
Trans Am Ophthalmol Soc. 1997;95:387-410; discussion 410-5
9440181
Surv Ophthalmol. 1992 Sep-Oct;37(2):73-116
1455302
Ophthalmic Surg Lasers. 1998 Aug;29(8):643-8
9715489
Ophthalmic Epidemiol. 1994 Dec;1(3):149-54
8790621