Aim: To evaluate the cost-effectiveness of first-eye cataract surgery compared to 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. 306 women over 70 years old with bilateral cataracts were randomised to cataract surgery (expedited, approximately 4 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 £2,004 (bootstrapped) more than the control group over one year (95% confidence interval £1,363 to £2,833, p<0.001), but experienced on average 0.456 fewer falls, an incremental cost per fall prevented of £4,390. The bootstrapped mean gain in Quality Adjusted Life Years (QALYs) per patient was 0.056 (95% confidence interval 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, whilst cost-ineffective over the trial period, was probably cost-effective over participants' remaining lifetime.
- Cataract surgery
- Cost utility analysis
- Economic evaluation