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Monali Malvankar, William Hodge, Richard Filek, Munir Iqbal, Muhammad Shakir, Madhukar Malvankar, Swati Chavda, Francie Si; Immediately Sequential Bilateral Cataract Surgery-A Cost-effective Procedure. Invest. Ophthalmol. Vis. Sci. 2013;54(15):4397.
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More than 2.5 million Canadians are currently suffering from cataract and this value is likely to double by 2031. According to Statistics Canada, there has been a constant increase in the percentage of population that entails seniors; it has been estimated that by 2031, seniors will make up 23% of the population of Canada. Increase in senior population will result in larger number of cataract surgeries performed per year. Moreover, one in three Canadian ophthalmologists are over the age of 55 and are due to retire in the next decade; it is expected that the ratio of ophthalmologists to people over 65 will drop about 43% over the next 15 years. Therefore it is necessary to choose a cost-effective cataract surgery that can compensate for negative correlation between number of ophthalmologists and cataract surgeries. There are two types of cataract surgeries: immediately sequential bilateral cataract surgery (ISBCS) and delayed sequential bilateral cataract surgery (DSBCS). ISBCS requires ophthalmologists to perform cataract surgery on both eyes on the same day. For DSBCS, cataract extractions for both eyes are done on different days. The purpose of the study was to perform cost-effectiveness analysis (CEA) of ISBCS by using current literature on cataract outcomes and complications.
We constructed a decision analytic model from the public third-party (Ministry of Health) payer’s perspective to conduct a CEA of both the surgeries, ISBCS and DSBCS. A study population consisted of adults with bilateral cataract surgery. Cost data consisted of the cost of the surgery, intravitreal injections, medications, and drops. The effectiveness was measured by the utility values associated with visual acuity in better seeing eye.
The mean discounted cost of the treatment of ISBCS was CAD$ 1335.85 and of DSBCS was CAD$ 1783.61. The difference between the two cataract surgeries, ISBCS and DSBCS - equaled a 0.08 net utility gain. The cost-effectiveness of ISBCS was calculated to be CAD$ 1391.51 per QALY gained per patient treated. A 3% annual discount rate was used resulting in 0.96 discounted QALYs gained over 12 year life expectancy.
Our research is the first step in performing such health economics assessment of ISBCS and the results of this economic evaluation will be useful for policy makers, clinicians, hospital administrators, and payers in order to put forward a protocol for performing ISBCS.
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