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Cataract surgery for falls prevention and improving vision: modelling the health gain, health system costs and cost-effectiveness in a high-income country
  1. Matt Boyd1,
  2. Giorgi Kvizhinadze2,
  3. Adeline Kho3,
  4. Graham Wilson3,
  5. Nick Wilson2
  1. 1Adapt Research Ltd, Reefton, New Zealand
  2. 2Public Health, University of Otago, Wellington, Wellington, New Zealand
  3. 3Department of Ophthalmology, Tairawhiti District Health Board, Gisborne, New Zealand
  1. Correspondence to Dr Matt Boyd, Adapt Research Ltd, Reefton, New Zealand; mattjamesboyd{at}gmail.com

Abstract

Aim To estimate the health gain, health system costs and cost-effectiveness of cataract surgery when expedited as a falls prevention strategy (reducing the waiting time for surgery by 12 months) and as a routine procedure.

Methods An established injurious falls model designed for the New Zealand (NZ) population (aged 65+ years) was adapted. Key parameters relating to cataracts were sourced from the literature and the NZ Ministry of Health. A health system perspective with discounting at 3% was used.

Results Expedited cataract surgery for 1 year of incident cases was found to generate a total 240 quality-adjusted life years (QALYs) (95% uncertainty interval (UI) 161 to 360) at net health system costs of NZ$2.43 million (95% UI 2.02 to 2.82 million) over the remaining lifetimes of the surgery group. This intervention was cost-effective by widely accepted standards with an incremental cost-effectiveness ratio (ICER) of NZ$10 600 (US$7540) (95% UI NZ$6030 to NZ$15 700) per QALY gained. The level of cost-effectiveness did not vary greatly by sex, ethnicity and previous fall history, but was higher for the 65–69 age group compared with the oldest age group of 85–89 years (NZ$7000 vs NZ$14 200 per QALY gained). Comparing cataract surgery with no surgery, the ICER was even more favourable at NZ$4380 (95% UI 2410 to 7210) per QALY. Considering only the benefits for vision improvement and excluding the benefits of falls prevention, it was still favourable at NZ$9870 per QALY.

Conclusions Expedited cataract surgery appears very cost-effective. Routine cataract surgery is itself very cost-effective, and its value appears largely driven by the falls prevention benefits.

  • cataracts
  • cataract surgery
  • cost-effectiveness
  • cost-utility
  • falls
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Footnotes

  • Contributors MB performed literature reviews, analysis and wrote the manuscript; GK performed analysis, performed the cost–utility modelling, constructed figures and helped revise the manuscript. AK performed literature reviews, assisted with manuscript writing and provided input at revision stage. GW conceived the study, assisted with manuscript writing and provided expert medical input. NW conceived the study, assisted with manuscript writing, provided expert medical input and provided important intellectual content for manuscript revisions.

  • Funding Rapanui Trust, Gisborne (for the lead author). Two of the other authors (GK and NW) were supported for development work on this model by the Health Research Council of New Zealand (grant no. 10/248) and the Ministry of Business, Innovation and Employment (MBIE) (grant no. UOOX1406).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available on reasonable request.

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