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      Cost-effectiveness analysis should continually assess competing health care options especially in high volume environments like cataract surgery

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          Abstract

          Context:

          Cost-effectiveness analysis should continually assess competing health care options especially in high volume environments like cataract surgery.

          Aims:

          To compare the cost effectiveness of phacoemulsification (PE) versus manual small-incision cataract surgery (MSICS).

          Settings and Design:

          Prospective randomized controlled trial. Tertiary care hospital setting.

          Subjects and Methods:

          A total of 52 consenting patients with age-related cataracts, were prospectively recruited, and block randomized to PE or MSICS group. Preoperative and postoperative LogMAR visual acuity (VA), visual function-14 (VF-14) score and their quality-adjusted life years (QALYs) were obtained, and the change in their values calculated. These were divided by the total cost incurred in the surgery to calculate and compare the cost effectiveness and cost utility. Surgery duration was also compared.

          Statistical Analysis Used:

          Two group comparison with Student's t-test. Significance set at P < 0.05; 95% confidence interval (CI) quoted where appropriate.

          Results:

          Both the MSICS and PE groups achieved comparative outcomes in terms of change (difference in mean [95% CI]) in LogMAR VA (0.03 [−0.05−0.11]), VF-14 score (7.92 [−1.03−16.86]) and QALYs (1.14 [−0.89−3.16]). However, with significantly lower costs (INR 3228 [2700–3756]), MSICS was more cost effective, with superior cost utility value. MSICS was also significantly quicker (10.58 min [6.85–14.30]) than PE.

          Conclusions:

          MSICS provides comparable visual and QALY improvement, yet takes less time, and is significantly more cost-effective, compared with PE. Greater push and penetration of MSICS, by the government, is justifiably warranted in our country.

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          Most cited references22

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          The VF-14. An index of functional impairment in patients with cataract.

          S D Cassard, Cara A Damiano, J Javitt … (1994)
          To describe the development and the performance of a brief questionnaire designed to measure functional impairment caused by cataract (the VF-14). Observational cross-sectional study. Patients were recruited between July 15 and December 15, 1991. Patients were recruited from the practices of 70 ophthalmologists, located in Columbus, Ohio (N = 21), St Louis, Mo (N = 26), and Houston, Tex (N = 23). Seven hundred sixty-six patients undergoing cataract surgery for the first time. Preoperative best corrected visual acuity in each eye; scores on the VF-14, a new index of functional impairment in patients with cataract; patient reports of overall trouble and satisfaction with their vision; and scores on the Sickness Impact Profile, a measure of general health status. The VF-14 has high internal consistency (Cronbach's alpha = .85) and correlates more strongly with the overall self-rating of the amount of trouble and satisfaction patients have with their vision than do several measures of visual acuity or the Sickness Impact Profile score. The VF-14 score is moderately correlated with visual acuity in the better eye. The VF-14 is a reliable and valid measure of functional impairment caused by cataract and provides information not conveyed by visual acuity or a general measure of health status.
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            A prospective randomized clinical trial of phacoemulsification vs manual sutureless small-incision extracapsular cataract surgery in Nepal.

            Leena Bajracharya, Antonie D. Kline, William Richheimer … (2006)
            To compare the efficacy and visual results of phacoemulsification vs manual sutureless small-incision extracapsular cataract surgery (SICS) for the treatment of cataracts in Nepal. Prospective, randomized comparison of 108 consecutive patients with visually significant cataracts. settings: Outreach microsurgical eye clinic. patients: One hundred eight consecutive patients with cataracts were assigned randomly to receive either phacoemulsification or SICS. intervention Cataract surgery with implantation of intraocular lens. main outcome measures: Operative time, surgical complications, uncorrected and best-corrected visual acuity (BCVA), astigmatism, and central corneal thickness (CCT). Both surgical techniques achieved excellent surgical outcomes with low complication rates. On postoperative day 1, the groups had comparable uncorrected visual acuity (UCVA) (P = 0.185) and the SICS group had less corneal edema (P = 0.0039). At six months, 89% of the SICS patients had UCVA of 20/60 or better and 98% had a best-corrected visual acuity (BCVA) of 20/60 or better vs 85% of patients with UCVA of 20/60 or better and 98% of patients with BCVA of 20/60 or better at six months in the phaco group (P = 0.30). Surgical time for SICS was much shorter than that for phacoemulsification (P < .0001). Both phacoemulsification and SICS achieved excellent visual outcomes with low complication rates. SICS is significantly faster, less expensive, and less technology dependent than phacoemulsification. SICS may be the more appropriate surgical procedure for the treatment of advanced cataracts in the developing world.
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              Safety and efficacy of phacoemulsification compared with manual small-incision cataract surgery by a randomized controlled clinical trial: six-week results.

              Bageshri Gogate, Y Krishnaiah, Anand Palimkar … (2005)
              To compare the efficacy, safety, and refractive errors of astigmatism after cataract surgery by phacoemulsification and manual small-incision cataract surgery techniques. Masked randomized control clinical trial. Four hundred eyes of 400 patients, 1:1 randomization with half in each arm of the trial. A total of 400 eyes was assigned randomly to either phacoemulsification or small-incision groups after informed consent and were operated on by 4 surgeons. They were masked to the technique of surgery before, during, and after cataract surgery and followed up to 1 year after surgery. The intraoperative and postoperative complications, uncorrected and best-corrected visual acuity, and astigmatism were recorded at 1 and 6 weeks postoperatively. The proportion of patients achieving visual acuity better than or equal to 6/18 with and without spectacles after cataract surgery in the operated eye up to 6 weeks, postoperative astigmatism, and complications during and after surgery. This article reports clinical outcomes up to 6 weeks. Three hundred eighty-three of 400 (95.75%) patients completed the 1-week follow-up, and 372 of 400 (93%) patients completed the 6-week follow-up. One hundred thirty-one of 192 (68.2%) patients in the phacoemulsification group and 117 of 191 (61.25%) patients in the small-incision group had uncorrected visual acuity better than or equal to 6/18 at 1 week (P = 0.153). One hundred fifty of 185 (81.08%) patients of the phacoemulsification group and 133 of 187 (71.1%) patients of the small-incision group (P = 0.038) were better than or equal to 6/18 at the 6-week follow-up for presenting visual activity. Visual acuity improved to > or = 6/18 with best correction in 182 of 185 patients (98.4%) and 184 of 187 (98.4%) patients (P = 0.549), respectively. Poor outcome (postoperative visual acuity < 6/60) was noted in 1 of 185 (0.5%) in the phacoemulsification group and none in the small-incision group. The mode of astigmatism was 0.5 diopters (D) for the phacoemulsification group and 1.5 D for the small-incision group, and the average astigmatism was 1.1 D and 1.2 D, respectively. There was an intra-surgeon variation in astigmatism. The phacoemulsification group had 7 posterior capsular rents compared with 12 in the small-incision group, but the phacoemulsification group had more corneal edema on the first postoperative day. Both the phacoemulsification and the small-incision techniques are safe and effective for visual rehabilitation of cataract patients, although phacoemulsification gives better uncorrected visual acuity in a larger proportion of patients at 6 weeks.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Indian J Ophthalmol
                Journal ID (iso-abbrev): Indian J Ophthalmol
                Journal ID (publisher-id): IJO
                Title: Indian Journal of Ophthalmology
                Publisher: Medknow Publications & Media Pvt Ltd (India )
                ISSN (Print): 0301-4738
                ISSN (Electronic): 1998-3689
                Publication date (Print): June 2015
                Volume: 63
                Issue: 6
                Pages: 496-500
                Affiliations
                [1]Institute of Ophthalmology, JNMC, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
                Author notes
                Correspondence to: Dr. Abadan Khan Amitava, Institute of Ophthalmology, JNMC, Aligarh Muslim University, Aligarh - 202 002, Uttar Pradesh, India. E-mail: akamitava@ 123456gmail.com
                Article
                Publisher ID: IJO-63-496
                DOI: 10.4103/0301-4738.162600
                PMC ID: 4550981
                PubMed ID: 26265639
                SO-VID: ac9ff112-3d4a-4d34-97c9-b1a893881e30
                Copyright © Copyright: © Indian Journal of Ophthalmology
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 24 February 2015
                Date accepted : 03 June 2015
                Categories
                Subject: Original Article

                ScienceOpen disciplines: Ophthalmology & Optometry
                Keywords: cost-effectiveness,manual small incision cataract surgery,phacoemulsification,quality adjusted life year,visual function-14
                Data availability:
                ScienceOpen disciplines: Ophthalmology & Optometry
                Keywords: cost-effectiveness, manual small incision cataract surgery, phacoemulsification, quality adjusted life year, visual function-14

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