Background/aims Children with bilateral cataracts may undergo immediate sequential bilateral cataract surgery (ISBCS), which involves surgery on both eyes during the same general anaesthesia, or delayed sequential bilateral cataract surgery (DSBCS), which involves operating on each eye on separate days and requires a second anaesthesia. ISBCS is viewed with caution because of the risk of bilateral endophthalmitis. Proponents of ISBCS emphasise that the incidence of serious complications is low and is outweighed by benefits such as avoidance of multiple anaesthesia, faster visual rehabilitation and potential for decreased costs. However, there is a paucity of literature regarding the cost-effectiveness of ISBCS in children. We conducted a cost-effectiveness analysis to determine whether ISBCS is more cost-effective than DSBCS from the societal and health system perspectives in Ontario, Canada, which has a universal, single-payer system.
Methods A retrospective analysis of children who underwent ISBCS or DSBCS at a tertiary referral paediatric hospital was conducted. A decision tree was constructed using TreeAge Pro 2018 software. Clear visual axis was the measure of effectiveness. A time horizon of 8 weeks postoperatively was adopted. Both direct and indirect costs were included.
Results Fifty-three children were included, 37 in the ISBCS group and 16 in the DSBCS group. ISBCS and DSBCS were equally effective. ISBCS resulted in cost-savings of $3,776 (95% CI:−$4,641 to $12,578) CAD, per patient, from the societal perspective and $2,200 (95% CI:−$5,615 to $10,373) CAD per patient from the health system perspective.
Conclusion ISBCS was less costly than DSBCS from both societal and health system perspectives while being equally effective.
- child health (paediatrics)
- treatment surgery
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Contributors AC, MJ, RAK, VB, KM and MEM developed the study design. AC, MJ, RK and MEM developed the decision model, guided by VB’s and KM’s clinical expertise. SK and VB performed data collection, while AC, MJ, RK and MEM led the interpretation and analysis of the data. AC led the writing of the manuscript. All authors contributed to critically revising the article for important intellectual content and final approval of the version to be published.
Funding AC is generously supported by the Hospital for Sick Children’s Research Training Centre through the Restracomp Master’s Scholarship, as well as by a Canada Graduate Scholarships Master’s Award (CGS-M) awarded by the Canadian Institutes of Health Research (CIHR). This economic evaluation was conducted as part of an academic training programme.
Competing interests None declared.
Patient consent for publication Not required.
Ethics approval This study has received ethics approval from the Research Ethics Board at the Hospital for Sick Children in Toronto, Ontario.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement No data are available.
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