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Falls and health status in elderly women following first eye cataract surgery: an economic evaluation conducted alongside a randomised controlled trial

Tracey H Sach¹, Alexander J E Foss², Richard M Gregson², Anwar Zaman², Francis Osborn², Tahir Masud³ and Rowan H Harwood³

¹ School of Chemical Sciences and Pharmacy, University of East Anglia, Norwich, UK
² Department of Ophthalmology, University Hospital, Queen’s Medical Centre, Nottingham, UK
³ Clinical Gerontology Research Unit, City Hospital, Nottingham, UK

Correspondence to:
Dr Tracey Sach, School of Chemical Sciences and Pharmacy, University of East Anglia, Norwich NR4 7TJ, UK; T.Sach{at}uea.ac.uk

Aim: To evaluate the cost-effectiveness of first eye cataract surgery compared with no surgery from a health service and personal social services perspective.

Methods: An economic evaluation undertaken alongside a randomised controlled trial of first eye cataract surgery in secondary care ophthalmology clinics. A sample of 306 women over 70 years old with bilateral cataracts was randomised to cataract surgery (expedited, approximately four weeks) or control (routine, 12 months wait); 75% of participants had baseline acuity of 6/12 or better. Outcomes included falls and the EuroQol EQ-5D.

Results: The operated group cost a mean £2004 (bootstrapped) more than the control group over one year (95% confidence interval (CI), £1363 to £2833) (p<0.001), but experienced on average 0.456 fewer falls, an incremental cost per fall prevented of £4390. The bootstrapped mean gain in quality adjusted life years (QALYs) per patient was 0.056 (95% CI, 0.006 to 0.108) (p<0.001). The incremental cost–utility ratio was £35 704, above the currently accepted UK threshold level of willingness to pay per QALY of £30 000. However, in an analysis modelling costs and benefits over patients’ expected lifetime, the incremental cost per QALY was £13 172, under conservative assumptions.

Conclusions: First eye cataract surgery, while cost-ineffective over the trial period, was probably cost-effective over the participants’ remaining lifetime.

Abbreviations: CEAC, cost-effectiveness acceptability curve; HRQL, health related quality of life; ICER, incremental cost-effectiveness ratio; QALY, quality adjusted life year; WTP, willingness to pay

Keywords: economic evaluation; cataract surgery; falls; elderly

Competing interests: None declared.

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This article has been cited by other articles:

• Desapriya, E, Scime, G, Pike, I, Joshi, P, Subzwari, S (2008). Cost effectiveness of cataract surgery. Br. J. Ophthalmol. 92: 722-722 [Full Text]  

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Cost effectiveness of cataract surgery

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BJO Online, 23 Jul 2007 [Full text]