Gary C Brown1, Melissa M Brown2, Brandon G Busbee3. 1. Center for Value-Based Medicine, Hilton Head, South Carolina; Eye Research Foundation, Philadelphia, Pennsylvania; Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania; Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia. Electronic address: gbrown@valuebasedmedicine.com. 2. Center for Value-Based Medicine, Hilton Head, South Carolina; Eye Research Foundation, Philadelphia, Pennsylvania; Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania; Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia. 3. Tennessee Retina, Nashville, USA.
Abstract
PURPOSE: To perform a cost-utility analysis of 2018 United States real dollars for cataract surgery. SETTING: Center for Value-Based Medicine, Hilton Head, South Carolina, USA. DESIGN: Cost-utility analysis. METHODS: A base-case 14-year cost-utility model using the ophthalmic cost perspective was used. Third-party insurer and societal cost perspectives were also analyzed. Patient outcomes and costs were discounted with net present value analysis at 3% a year. RESULTS: First-eye cataract surgery resulted in a 2.523 quality-adjusted life-year (QALY) gain, a 33.3% patient value gain, and 25.5% quality-of-life gain. Bilateral surgery yielded a 44.1% patient value gain, while second-eye cataract surgery alone conferred an 8.1% value gain. First-eye cataract surgery resulted in a gain of 2.52 QALYs, while second-eye surgery added an incremental gain of 0.81 QALYs. The ophthalmic-cost-perspective average cost-utility ratio was $2526/2.523 = $1001/QALY for first-eye cataract surgery. The societal-cost-perspective average cost-utility ratio was -$370 018/2.523 = -$146 629/QALY. The second-eye ophthalmic-cost-perspective cost-utility ratio was $2526/0.814 = $3101/QALY, while the ophthalmic-cost-perspective cost-utility ratio for bilateral cataract surgery was $5052/3.338 = $1514/QALY. The 14-year U.S. 2018 real-dollar societal-cost-perspective net return on investment for first-eye cataract surgery was $370 018 above the $2526 cost expended for cataract surgery. CONCLUSIONS: Cataract surgery in both the first eye and second eye, when analyzed by standard health economic methodologies, is highly cost-effective. Cataract surgery in 2018 was 73.7% more cost-effective than in 2000.
PURPOSE: To perform a cost-utility analysis of 2018 United States real dollars for cataract surgery. SETTING: Center for Value-Based Medicine, Hilton Head, South Carolina, USA. DESIGN: Cost-utility analysis. METHODS: A base-case 14-year cost-utility model using the ophthalmic cost perspective was used. Third-party insurer and societal cost perspectives were also analyzed. Patient outcomes and costs were discounted with net present value analysis at 3% a year. RESULTS: First-eye cataract surgery resulted in a 2.523 quality-adjusted life-year (QALY) gain, a 33.3% patient value gain, and 25.5% quality-of-life gain. Bilateral surgery yielded a 44.1% patient value gain, while second-eye cataract surgery alone conferred an 8.1% value gain. First-eye cataract surgery resulted in a gain of 2.52 QALYs, while second-eye surgery added an incremental gain of 0.81 QALYs. The ophthalmic-cost-perspective average cost-utility ratio was $2526/2.523 = $1001/QALY for first-eye cataract surgery. The societal-cost-perspective average cost-utility ratio was -$370 018/2.523 = -$146 629/QALY. The second-eye ophthalmic-cost-perspective cost-utility ratio was $2526/0.814 = $3101/QALY, while the ophthalmic-cost-perspective cost-utility ratio for bilateral cataract surgery was $5052/3.338 = $1514/QALY. The 14-year U.S. 2018 real-dollar societal-cost-perspective net return on investment for first-eye cataract surgery was $370 018 above the $2526 cost expended for cataract surgery. CONCLUSIONS:Cataract surgery in both the first eye and second eye, when analyzed by standard health economic methodologies, is highly cost-effective. Cataract surgery in 2018 was 73.7% more cost-effective than in 2000.