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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 Sach1,
  2. Alexander J E Foss2,
  3. Richard M Gregson2,
  4. Anwar Zaman2,
  5. Francis Osborn2,
  6. Tahir Masud3,
  7. Rowan H Harwood3
  1. 1
    School of Chemical Sciences and Pharmacy, University of East Anglia, Norwich, UK
  2. 2
    Department of Ophthalmology, University Hospital, Queen’s Medical Centre, Nottingham, UK
  3. 3
    Clinical Gerontology Research Unit, City Hospital, Nottingham, UK
  1. Dr Tracey Sach, School of Chemical Sciences and Pharmacy, University of East Anglia, Norwich NR4 7TJ, UK; T.Sach{at}


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.

  • economic evaluation
  • cataract surgery
  • falls
  • elderly

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  • Competing interests: None declared.

  • Abbreviations:

    cost-effectiveness acceptability curve


    health related quality of life


    incremental cost-effectiveness ratio


    quality adjusted life year


    willingness to pay