Abstract
Aim
The aim of this study was to evaluate the cost-effectiveness of second-eye cataract surgery for older women with minimal visual dysfunction in the eye to be operated on from a Health and Personal Social Services perspective, compared to waiting list controls who had already undergone first-eye cataract surgery.
Methods
A cost-utility analysis was undertaken alongside a randomized controlled trial of second-eye cataract surgery in secondary care ophthalmology clinics. A total of 239 women over 70 years old with one unoperated cataract were randomized to cataract surgery (expedited, approximately 4 weeks) or control (routine surgery, 12 months wait). Outcomes were measured in terms of quality-adjusted life years (QALYs), with health-related quality of life estimated using the EuroQol EQ-5D.
Results
The operated group had costs which were, on average, £646 more than the control group (95% confidence interval, £16–1276, P<0.04) and had a mean QALY gain of 0.015 (95% confidence interval, −0.039 to 0.068, P=0.59) per patient over 1 year. Therefore, the incremental cost-utility ratio was £44 263 over the 1-year trial period. In an analysis modelling costs and benefits over patients’ expected lifetime, the incremental cost per QALY was £17 299, under conservative assumptions.
Conclusions
Second-eye cataract surgery is not likely to be cost-effective in the short term for those with mild visual dysfunction pre-operation. In the long term, second-eye cataract surgery appears to be cost-effective unless carer costs are included.
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Acknowledgements
We acknowledge the funding provided by the former Trent Regional NHS Research and Development scheme and the PPP Foundation (now the Health Foundation) that made the study possible. The funders had no role in the conduct, analysis or reporting of the study.
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Sach, T., Foss, A., Gregson, R. et al. Second-eye cataract surgery in elderly women: a cost-utility analysis conducted alongside a randomized controlled trial. Eye 24, 276–283 (2010). https://doi.org/10.1038/eye.2009.112
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DOI: https://doi.org/10.1038/eye.2009.112
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