June 2013
Volume 54, Issue 15
Free
ARVO Annual Meeting Abstract  |   June 2013
A combined decision and Markov model comparison of the economic burden of cataract surgery for a United States patient in the United States versus medical tourism
Author Affiliations & Notes
  • Ronald Rebenitsch
    Ophthalmology, University of Missouri-Kansas City, Kansas City, MO
  • David Camejo
    Ophthalmology, University of Missouri-Kansas City, Kansas City, MO
  • Mahendra Rupani
    Ophthalmology, University of Missouri-Kansas City, Kansas City, MO
  • Footnotes
    Commercial Relationships Ronald Rebenitsch, None; David Camejo, None; Mahendra Rupani, None
  • Footnotes
    Support None
Investigative Ophthalmology & Visual Science June 2013, Vol.54, 805. doi:
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      Ronald Rebenitsch, David Camejo, Mahendra Rupani; A combined decision and Markov model comparison of the economic burden of cataract surgery for a United States patient in the United States versus medical tourism. Invest. Ophthalmol. Vis. Sci. 2013;54(15):805.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract
 
Purpose
 

As a result of soaring medical costs and lack of medical coverage, medical tourism has grown to a $100 billion industry as of 2012. India, South Korea, Singapore, Hong Kong, Malaysia, and Thailand have become strong players as important medical tourism destinations with a combined 1.3 million “tourists” each year. As cataract surgery is the most commonly performed surgery in the U.S., we aimed to perform a probability comparison of the economic burden of cataract surgery in the U.S. and abroad for an American patient.

 
Methods
 

Through a combined decision and Markov model analysis, we modeled a hypothetical cohort of people with visually significant cataract(s) undergoing cataract surgery according to Medicare and other published guidelines. We used published and solicited cost and probability data in the U.S., Mexico, Spain, the United Kingdom, Hungary, Malaysia, Thailand, Germany, India, and Turkey. Travel and lodging costs were determined using online search engines to find a probable range of costs. We compared costs of doing surgery in one and both eyes; probabilities of complications and associated costs were included. Sensitivity analysis was then performed to determine thresholds.

 
Results
 

The overall economic burden for a theoretical American patient undergoing bilateral cataract surgery in the United States had a mean of $5245. Germany, Thailand, Hungary, Turkey, and India had lower overall mean economic burden for bilateral cataract surgery at $4400, $5074, $5160, $4546, and $4912, respectively. The highest economic burden bilateral surgery was in Malaysia at a mean of $7522. A patient undergoing unilateral surgery had the lowest economic burden in the U.S. at $2692. One way sensitivity analysis of the costs of travel and surgery can be seen in Figures 1 and 2, respectively.

 
Conclusions
 

With the overall economic burden of cataract surgery comparable or more expensive abroad and with the associated difficulties with travel and follow up, we recommend that individual judgment be used in determining where cataract surgery be performed at this time.

     
Keywords: 459 clinical (human) or epidemiologic studies: biostatistics/epidemiology methodology • 445 cataract • 473 computational modeling  
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