title: Immediately sequential bilateral cataract surgery: a cost-effective procedure.
abstract: OBJECTIVE
  The objective of this project was to perform a cost-effectiveness analysis (CEA) of immediately sequential bilateral cataract surgery (ISBCS) versus delayed sequential bilateral cataract surgery (DSBCS) to determine whether ISBCS represents an appropriate, cost-effective way to rapidly rehabilitate a patient's visual impairment.
  
  
  METHODS
  A systematic review followed by a primary economic analysis with computer-based econometric modeling.
  
  
  METHODS
  Not applicable.
  
  
  METHODS
  We constructed a decision analytic model from the perspective of the public third-party payer (i.e., the Ministry of Health) to conduct a CEA of both surgeries, ISBCS and DSBCS. Cost data consisted of the costs of the surgery, intravitreal injections, medications, and drops, all of which were obtained from a comprehensive literature search and from records at St. Joseph's Hospital, London, Ont. The effectiveness was measured by the utility values associated with visual acuity in the better seeing eye.
  
  
  RESULTS
  ISBCS resulted in an incremental effectiveness of 0.08 utility at an incremental cost of $1607. Discounting the quality-adjusted life-years (QALYs) gained by an annual interest rate of 3% resulted in 0.932 QALYs gained. The cost-effectiveness of ISBCS was calculated to be $1431 per QALY gained. A 1-way sensitivity analysis was performed by varying costs, utility values, probabilities, and discounting rates. This analysis varied the incremental cost-effectiveness ratio but did not change the conclusion.
  
  
  CONCLUSIONS
  Health economics assessment showed that, compared with DSBCS, ISBCS is a cost-effective procedure. This finding will be highly useful to policy-makers, decision-makers, clinicians, hospital administrators, and payers in making cost-efficient decisions.
authors: Departments of Ophthalmology, Physiology and Health Sciences, Western University, London, Ont.. Electronic address: Monali.Malvankar@schulich.uwo.ca.
authors: Monali S
authors: MS
authors: Malvankar-Mehta
authors: Richard
authors: R
authors: Filek
authors: Munir
authors: M
authors: Iqbal
authors: Abubakar
authors: A
authors: Shakir
authors: Alex
authors: A
authors: Mao
authors: Francie
authors: F
authors: Si
authors: Madhukar G
authors: MG
authors: Malvankar
authors: Siddhartha S
authors: SS
authors: Mehta
authors: William G
authors: WG
authors: Hodge
mesh_terms: D002387:Cataract Extraction / Q000191:economics*; D003362:Cost-Benefit Analysis; D007839:Functional Laterality; D006801:Humans; D019654:Lens Implantation, Intraocular / Q000191:economics*; D017059:Models, Econometric; D009885:Ophthalmology / Q000191:economics; D017063:Outcome Assessment, Health Care; D019057:Quality-Adjusted Life Years