Incremental Cost-effectiveness of Initial Cataract Surgery

Purpose: 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. Design: Computer-based econometric modeling. Methods: 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. Main Outcome Measures: 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. Results: 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. The cos