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Lisa J Keay, Vu Quang Do, Anna Palagyi, Peter J McCluskey, Andrew JR White, Nicole Carnt, Fiona Stapleton, Tracey-Lea Laba; Deciding where to access cataract surgery: a discrete choice experiment in Australia. Invest. Ophthalmol. Vis. Sci. 2017;58(8):1620.
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Age-related cataract is a leading cause of vision impairment in older adults and providing timely access to surgery is an ongoing challenge. This study investigated preferences for cataract surgery services amongst adults with cataract in two urban public hospitals in Australia.
Key attributes considered when selecting a cataract surgery service were determined by semi-structured patient interviews and these informed the design of a discrete choice experiment (DCE). Patients at cataract clinics of Sydney Eye and Westmead Hospitals in Sydney, Australia were administered the DCE survey which involved choices between two hypothetical services (8 sets). A multinomial logit model was used to estimate the odds ratios (OR) for preferring a surgical service and willingness to pay for a unit change in non-cost attributes.
Five key service attributes were identified from the qualitative interviews: out-of-pocket cost, waiting time, institutional reputation, surgeon experience and travel time. A total of 74 patients completed the DCE: 33 (45%) were female and average age was 68±9 years (range 47-82). The majority of patients were retired and on a government pension (48, 66%) and spoke English at home (51, 70%). Thirteen patients (18%) had private health insurance. Surgical service preference increased with an experienced surgeon (OR 1.76, 95% CI 1.50-2.08) and at an institution with a good reputation (OR 1.53, 95% CI 1.38-1.71), but decreased with every month longer wait for surgery (OR 0.93, 95% CI 0.90-0.97) and $100 increase in out-of-pocket cost (OR 0.92, 95% CI 0.87-0.97). Travel time did not influence preference (OR 0.94, 95% CI 0.77-1.15 per hour). Respondents were willing to pay AU$519 [US$388] (95% CI 440-776) to reduce their wait time by 6 months, AU$719 [US$538] (95% CI 525-1501) for an experienced surgeon and AU$540 [US$404] (384-1180) to receive surgery at an institution with a good reputation.
This study provides insight into public hospital patient preferences for cataract surgery services in Australia. Surgeon experience, institutional reputation and waiting time were all valued by patients, and cost was a major consideration. Patients were willing to pay for these attributes, however projected figures were modest and most likely reflect limited financial resources, explaining the reliance on public hospital services which are provided at no cost.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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