1 Title: Cost Efficiency and Cost Effectiveness of Cataract Surgery at Malaysian Ministry of Health Ophthalmic Services

Purpose: To determine the cost efficiency and to compare the cost effectiveness of conventional extracapsular cataract surgery (ECCE) and phacoemulsification at three hospitals of Malaysian Ministry of Health (MOH). Methods: Patient demography, pre-operative visual acuity, intra-operative complications, post-operative complications and post-operative visual acuity were recorded for two hundred and forty seven of the 400 patients who had cataract surgeries performed during a 2-week period. The cost of surgery, which included capital, staff and overhead, and patient care consumable costs was assessed prospectively in 8 randomly sampled patients over a 3-month period. Cost efficiency refers to cost per cataract surgery. Cost effectiveness refers to cost per successful cataract surgery. This is estimated by the ratio of cost efficiency to the proportion of successful cataract surgery. Successful surgery was defined as best corrected visual acuity (BCVA) of better than 6/12 at 3 months post-operatively. Results: Proportion of patients who had post-operative visual acuity of 6/12 or better was higher in phacoemulsification group (94%) as compared to ECCE group (81%). Conventional extracapsular cataract surgery with intraocular lens implant costs RM3442 (USD905.79) an