A Cost-Effectiveness Analysis of Different Cataract SurgeryTake a Regional Teaching Hospital for Example

Purpose:o compare the cost-effectiveness of three cataract surgical techniques （conventional extracapsular cataract extraction （ECCE）,phacoemulsification with foldable three-piece hydrophobic acrylic soft intra-ocular lens（FoldSoftPhaco）, hacoemulsification with injection single-piece hydrophobic acrylic soft intra-ocular lens （InjSoftPhaco） in a public regional teaching hospital ,Taiwan,ROC.etting:he consecutive series comprised 845 eyes , mean age was 72.2± SD 8.9 Y/O（27 through 98 Y/O）, having ambulatory cataract surgery performed by one experienced extracapsular surgeon. The search was restricted to the years 1997 through 2005.esign:omputer-based decision analysis and Economic evaluation modeling of health care. These include cost-effectiveness analysis of cataract surgery in the first and second eyes.ethods:he patient''s age, sex, axial length, anterior chamber depth, intraocular pressure, cornea astigmatism, pre-operative visual acuity, nuclear density, operation duration, per-operative complications, post-operative visual acuity and ocular comorbidity were documented. Average follow-up periods were 28.5±25.7(SD) months（1 through 106 months）ll case-control comparisons were stratified into four subgroups：roup A：the first eye operation without ocular comorbidity, 389 cases。roup B：the first eye operation with ocular comorbidity, 146 cases。roup C：the second eye operation without ocular comorbidity , 221 cases。roup D：the second eye operation with ocular comorbidity , 56 cases。ata of the relevant cost and outcomes were collected. The compound data were connected with survival analysis ,time-trade-off （TTO）utility values, decision analysis, and econometric modeling to perform the cost effectiveness analysis（CEA）. esults：amp;#65339;1］absolute value of the prediction error of Intraocular lens power calculation （3rd month）≦1D： comparison of three surgical techniques, Group A ：no statistical significance P（X2m）=0.076 , Group B：had statistical significance P（X2m）=0.001, Group C：had statistical significance P（X2m）=0.0045 , Group D：no statistical significance P（X2m）=0.34 ［2］absolute value of the surgical induced astigmatism （3rd month）≦1 D： comparison of three surgical techniques , Group A and Group D had statistical significance, Group A：P（X2m）= 0.003 ,Group B：P（X2m）=0.06 , Group C：P（X2m）=0.07 ,Group D：P（X2m）= 0.04 , ［3］ the post-operative visual acuity≧0.5 , comparison of three surgical techniques：Group A：ECCE：88.1% 、FoldSoftPhaco：94.6% , InjSoftPhaco：92.2 % ,no statistical significance P（X2m）=0.214 , Group B：ECCE：63.9 % , FoldSoftPhaco：87.1 %, InjSoftPhaco ：66.7 % , had statistical significance P（X2）=0.013。 Group C：ECCE：81.8 % 、FoldSoftPhaco：95.2 %、 InjSoftPhaco：97.6% ,had statistical significance P（X2m）=0.011 , Group D：ECCE：62.5 % ,FoldSoftPhaco：88.9% , InjSoftPhaco：66.7% ,no statistical significance P（X2m）=0.67 , ［4］the Log MAR line gained ≧one line： comparison of three surgical techniques： Group A：ECCE：96.8% ,FoldSoftPhaco：95.3% , InjSoftPhaco：97.3% ,Group B：ECCE：96.8% , FoldSoftPhaco：94.8% , InjSoftPhaco：90.9% , Group C：ECCE：95.2% , FoldSoftPhaco：97.5% , InjSoftPhaco：91.7% , Group D：ECCE：100%, FoldSoftPhaco：92.0%, InjSoftPhaco：100% , ［5］The average cost of a cataract surgery for the hospital（not include costs of care）ECCE：NT 18,098 ,FoldSoftPhaco NT22,965 ,InjSoftPhaco NT 23,395 , Cost-Effectiveness Ratio（A 3% annual discount rate was used to account for the QALYs gain over 5 years, costs without discount）： Group A： ECCE： NT34,900 $/QALY, FoldSoftPhaco： NT34,171 $ /QALY ,InjSoftPhaco： NT34,383 $ /QALY, Group B：ECCE： NT 37,080 $ /QALY, FoldSoftPhaco： NT36,896 $/QALY,InjSoftPhaco：NT 44,976 $/QALY, Group C：ECCE： NT 49,136$ /QALY, FoldSoftPhaco： NT 45,318 $/QALY,InjSoftPhaco： NT 40,275$ /QALY , Group D： ECCE：NT 33,925$ /QALY, FoldSoftPhaco： NT 41,724$ /QALY,InjSoftPhaco： NT 35,817 $/QALYonclusions:hacoemulsification needs additional cost for the machine (depreciation), replenishment of parts, and annual maintenance contract, and so phacoemulsification is more expensive than conventional extracapsular cataract extraction.owever phacoemulsification had the advantages of effectiveness such as the lower prediction error of Intraocular lens power calculation , the lower surgical induced astigmatism , the more clear posterior capsule ,and the rapid visual recovery when compared to ECCE in the more than 3 months follow – up.n group A and C groups without ocular comorbidity, InjSoftPhaco and FoldSoftPhaco procedure were shown to be a highly cost-effective option compared with ECCE procedure. The cost-effectiveness of second-eye surgery （group C）diminished from first-eye cataract surgery（group A） , otherwise it needs further related factors analysis of effectiveness and costs in group B and D groups with ocular comorbidity due to wide variation in case-mix.