Journal of American Association for Pediatric Ophthalmology and Strabismus
Major articleThe Cost Utility of Strabismus Surgery in Adults
Section snippets
Participants
Consecutive adult patients with strabismus who visited a private practice setting were prospectively invited to participate. Participants signed a written informed HIPAA-compliant consent approved by the Institutional Review Board of the University of Texas Southwestern Medical Center. Participants were categorized as presurgical patients if they were scheduled (or planned to be scheduled) to undergo strabismus surgery, as postsurgical patients if they had recently undergone strabismus surgery,
Results
Preoperatively, the mean utility was 0.85 (SD 0.20) with the distribution shown by the light shaded bars in Figure 1. Ten patients indicated that, under the hypothetical scenario outlined in the time tradeoff question, they would not be willing to trade any portion of their life expectancy, ie, their preoperative utility was 1. Postoperatively, the mean utility was 0.96 (SD 0.11; dark shaded bars in Figure 1). Figure 2 shows the postoperative gain in utility. The overall 0.1175 mean gain in
Discussion
In the United States, treatments with an associated incremental cost-utility of less than $50,000/QALY are generally considered “very cost-effective.” The utility gain associated with strabismus surgery was measured in a group of adult patients, and a cost model for strabismus surgery was proposed. Based on the model and the measured utility gain, we demonstrated that strabismus surgery in adults is very cost-effective.
The presented data also confirm the substantial decrement in quality of life
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Cited by (42)
Psychosocial impacts of adult strabismus and strabismus surgery: a review of the literature
2020, Canadian Journal of OphthalmologyCitation Excerpt :Surgical correction of strabismus in adults has been shown to be cost-effective, with a cost utility of US$1600/quality-adjusted life year (QALY) and a mean value gain of 2.61 QALYs.24 The same study references 3 other studies that show cost utilities of US $2093/QALY for first eye cataract surgery, US $2863/QALY for second eye cataract surgery, and US $2038/QALY for pars plana vitrectomy for diabetic vitreous haemorrhage.26 Thus strabismus surgery is cost-effective relative to other common ophthalmic procedures.
Clinical profiles and surgical outcomes of adult esotropia
2017, Canadian Journal of OphthalmologyCitation Excerpt :In fact, Beauchamp et al. demonstrated that patients were willing to trade a portion of their life expectancy to get rid of diplopia and asthenopia.12 Physician ratings of the degree of asthenopia and diplopia also correlated well with utility.12,13 Despite the distressing aspects of asthenopia, only 20% of our patients reported significant symptoms.
Bifocals fail to improve stereopsis outcomes in high AC/A accommodative esotropia
2016, OphthalmologyCitation Excerpt :Bifocals add $60 to the average cost of spectacle lenses (Cohen D, personal communication, 2015), meaning that the total additional cost of bifocal therapy may be $864000 annually. Furthermore, if our estimate of a 15% incidence of surgery among bifocal patients (vs. a 4% incidence among single-vision patients) over a 4-year care interval is borne out in a prospective study, and if the cost of strabismus surgery is $5028 (in 2015 dollars),10 there would be 400 fewer surgeries annually, for a savings of $2 million. Thus, a prospective study confirming our preliminary findings either could justify or eliminate health care expenditures of $800000 to $2.8 million annually in the United States alone.
Visuomotor control following surgical correction of strabismus in adults
2013, Canadian Journal of OphthalmologyCitation Excerpt :Possibly, patients may have developed sensitivity to monocular cues, and would have sufficient expertise with these cues to make the relearning difficult initially. Alignment of eyes improves stereopsis/depth perception and removes debilitating diplopia14–18; the present findings suggest that possibly patients are not able to use binocular cues for daily manual tasks immediately after straightening, although these patients did very well with clinical tests for stereopsis/binocularity. These clinical tests give an excellent idea of binocularity but do not give good information on how it quantitatively affects our day-to-day life manual tasks.