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Open Access Research

Cost-utility of routine cataract surgery

Pirjo Räsänen1*, Kari Krootila2, Harri Sintonen3, Tiina Leivo2, Anna-Maija Koivisto4, Olli-Pekka Ryynänen5, Marja Blom6 and Risto P Roine1

Author Affiliations

1 Helsinki and Uusimaa Hospital Group, Group Administration, P.O.Box 440, 00029 HUS, Helsinki, Finland

2 Helsinki University Eye Hospital, P.O.Box 220, 00029 HUS, Helsinki, Finland

3 University of Helsinki, Department of Public Health and Finnish Office for Health Technology Assessment, Helsinki, Finland P.O.Box 41, 00014 Yliopisto, Helsinki, Finland

4 University of Tampere, School of Public Health, 33014 Yliopisto, Tampere, Finland

5 University of Kuopio, Department of Health Policy and Management, P.O.Box 1627, 70211 Kuopio, Finland

6 Academy of Finland, c/o Stakes and Jorvi Hospital, Espoo, Finland, P.O.Box 220, 00531 Helsinki, Finland

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Health and Quality of Life Outcomes 2006, 4:74  doi:10.1186/1477-7525-4-74

Published: 29 September 2006

Abstract

Background

If decisions on health care spending are to be as rational and objective as possible, knowledge on cost-effectiveness of routine care is essential. Our aim, therefore, was to evaluate the cost-utility of routine cataract surgery in a real-world setting.

Methods

Prospective assessment of health-related quality of life (HRQoL) of patients undergoing cataract surgery. 219 patients (mean (SD) age 71 (11) years) entering cataract surgery (in 87 only first eye operated, in 73 both eyes operated, in 59 first eye had been operated earlier) filled in the 15D HRQoL questionnaire before and six months after operation. Direct hospital costs were obtained from a clinical patient administration database and cost-utility analysis performed from the perspective of the secondary care provider extrapolating benefits of surgery to the remaining statistical life-expectancy of the patients.

Results

Mean (SD) utility score (on a 0–1 scale) increased statistically insignificantly from 0.82 (0.13) to 0.83 (0.14). Of the 15 dimensions of the HRQoL instrument, only seeing improved significantly after operation. Mean utility score improved statistically significantly only in patients reporting significant or major preoperative seeing problems. Of the subgroups, only those whose both eyes were operated during follow-up showed a statistically significant (p < 0.001) improvement. Cost per quality-adjusted life year (QALY) gained was €5128 for patients whose both eyes were operated and €8212 for patients with only one eye operated during the 6-month follow-up. In patients whose first eye had been operated earlier mean HRQoL deteriorated after surgery precluding the establishment of the cost per QALY.

Conclusion

Mean utility gain after routine cataract surgery in a real-world setting was relatively small and confined mostly to patients whose both eyes were operated. The cost of cataract surgery per quality-adjusted life year gained was much higher than previously reported and associated with considerable uncertainty.