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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
  1. Tracey H Sach (tracey.sach{at}nottingham.ac.uk),
  2. Alexander Foss (alexander.foss{at}btinternet.com),
  3. Richard Gregson (richard.gregson{at}nuh.nhs.uk),
  4. Anwar Zaman (anwar.zaman{at}nuh.nhs.uk),
  5. Francis Osborn,
  6. Tahir Masud (tahir.masud{at}nuh.nhs.uk),
  7. Rowan H Harwood (rowan.harwood{at}ntlworld.com)
  1. University of Nottingham, United Kingdom
  2. Nottingham University Hospitals, United Kingdom
  3. Nottingham University Hospitals, United Kingdom
  4. Nottingham University Hospitals, United Kingdom
  5. Nottingham University Hospitals, United Kingdom
  6. Nottingham University Hospitals, United Kingdom
  7. Nottingham University Hospitals, United Kingdom

    Abstract

    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
    • Elderly
    • Falls

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