Major article
The Cost Utility of Strabismus Surgery in Adults

https://doi.org/10.1016/j.jaapos.2006.06.004Get rights and content

Purpose

Cost-utility analysis evaluates the cost of medical care in relation to the gain in quality-adjusted life years (QALYs). Our purpose was to develop a cost model for surgical care for adult strabismus, to estimate the mean cost per case, to determine the associated gain in QALYs, and to perform cost-utility analysis.

Methods

A cost model incorporated surgery, pre- and postoperative care, and a mean of 1.5 procedures per patient. The gain in QALYs was based on the improvement of utility on a scale from 0 (death) to 1 (perfect health). Utility was measured through physician-conducted interviews employing a time tradeoff question (seeking to estimate the portion of life expectancy a patient would be willing to trade for being rid of disease and associated effects). The interviews were conducted before and 5 to 8 weeks after surgery in 35 strabismic patients (age 19-75 years).

Results

The cost model resulted in an estimated total cost of $4,254 per case. A significant improvement of utility was found: 0.96 ± 0.11 postoperatively versus 0.85 ± 0.20 preoperatively (p = 0.00008). Based on the mean life expectancy (36.0 years) of these patients, and discounting outcomes and costs by 3% annually, this resulted in a mean value gain of 2.61 QALYs after surgery and a cost-utility for strabismus surgery of $1,632/QALY.

Conclusions

In the United States, treatments <$50,000/QALY are generally considered “very cost-effective.” Strabismus surgery in adults falls well within this range.

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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