September 2016
Volume 57, Issue 12
Open Access
ARVO Annual Meeting Abstract  |   September 2016
Cataract Surgery in Hospice Patients: Pros, Cons and Cost-Effectiveness
Author Affiliations & Notes
  • Joshua Nunn
    Ophthalmology, Penn State Hershey Medical Center, Harrisburg, Pennsylvania, United States
  • Seth Pantanelli
    Ophthalmology, Penn State Hershey Medical Center, Harrisburg, Pennsylvania, United States
  • Ingrid U Scott
    Ophthalmology, Penn State Hershey Medical Center, Harrisburg, Pennsylvania, United States
  • Scott Shreve
    Lebanon VA Medical Center, Lebanon, Pennsylvania, United States
  • Footnotes
    Commercial Relationships   Joshua Nunn, None; Seth Pantanelli, Alcon (R); Ingrid Scott, None; Scott Shreve, None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science September 2016, Vol.57, 6234. doi:
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      Joshua Nunn, Seth Pantanelli, Ingrid U Scott, Scott Shreve; Cataract Surgery in Hospice Patients: Pros, Cons and Cost-Effectiveness. Invest. Ophthalmol. Vis. Sci. 2016;57(12):6234.

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

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Abstract

Purpose : Hospice care focuses on improving quality of life (QOL) rather than prolonging life. The purpose of this study is to investigate the pros, cons, and cost-effectiveness of performing cataract surgery in hospice patients.

Methods : The pros and cons of cataract surgery in hospice patients are described. To assess cost effectiveness, the cost per quality adjusted life year (QALY) was calculated and compared to the cost per QALY of hemodialysis. Many previous studies have used the annual cost of hemodialysis as the benchmark to define societal willingness to pay for a QALY, arguing that the federal entitlement to Medicare insurance coverage for patients with chronic renal failure implies a societal judgment that the program’s benefits are worth its cost. To calculate the cost per QALY of cataract extraction, CMS.gov was queried to determine the average Medicare reimbursement for uncomplicated cataract extraction. This was combined with previously published calculations of the QALY gained from cataract extraction. The cost per QALY of hemodialysis was determined using previously published calculations.

Results : Cataract surgery in hospice patients is a relatively safe intervention that can improve QOL. However, risks include complications requiring more surgery, a small risk of intraoperative death, and the stigmata surgeons face if post-surgical patients expire within 30 days. The average cost of cataract extraction is $650.40 per procedure. Previous work has shown the total Medicare cost of hemodialysis per person per year is $84,550. It has been shown that the utility gain for cataract surgery is 0.148 QALY/year and hemodialysis confers a benefit of 0.66 QALY/year. The average length of hospice service is 72.6 days. Based on this information, the average cost per QALY of performing cataract extraction in a hospice patient is $22,100/QALY, and the average cost per QALY of hemodialysis is $128,000/QALY.

Conclusions : Performing cataract surgery in a person with limited life expectancy is controversial. It improves QOL by allowing individuals to see loved ones and enjoy activities otherwise impossible, such as reading or watching television. However, the intervention comes with risks including possible complications or intraoperative death. Cost-effectiveness analysis suggests cataract surgery in hospice patients is acceptable in those with life expectancies of as little as 12-13 days.

This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.

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