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Abstract
The purpose of this study was to perform a reference case, cost-utility analysis of
initial cataract surgery using the current literature on cataract outcomes and complications.
Computer-based econometric modeling.
Visual acuity data of patients treated and observed over a 4-month postoperative period
was obtained from the US National Cataract Patient Outcomes Research Team (PORT).
The results from this prospective study were combined with other studies that investigated
the complication rates of cataract surgery to complete the cohort of patients and
outcomes. These synthesized data were incorporated with time-tradeoff utility values,
decision analysis, and econometric modeling to account for the time value of money.
The number of quality-adjusted life-years (QALYs) gained was calculated for the study
group undergoing cataract extraction in the first eye when the vision was the same
in both eyes. This was divided into the cost of the procedure to find the year 2000
nominal US dollars spent per quality-adjusted life-year ($/QALY) gained.
Initial cataract surgery, compared with observation, resulted in a mean gain of 1.776
QALYs per patient treated. A 3% annual discount rate was used to account for the benefit
over time, yielding 1.25 QALYs gained. The mean cost of treatment (also discounted
at a 3% annual rate) of each patient totaled 2525 US dollars. The cost divided by
the discounted benefit resulted in $2020/QALY gained for this procedure.
Initial cataract surgery seems to be highly cost-effective compared with procedures
across multiple medical specialties. This information, incorporating patient preferences
into evidenced-based medicine, will play an increasingly important role in the evaluation
of health care in the future.