Is cataract surgery cost-effective among older patients with a low predicted probability for improvement in reported visual functioning?

Med Care. 2006 Nov;44(11):982-9. doi: 10.1097/01.mlr.0000228216.18270.3e.


Introduction: Although cataract surgery has been demonstrated to be effective and cost-effective, 5% to 20% of patients do not benefit functionally from the procedure. This study examines the cost-effectiveness of cataract surgery versus watchful waiting in a subgroup of patients who had less than a 30% predicted probability of reporting improvements in visual function after surgery.

Methods: Randomized trial (first eye surgery vs. watchful waiting) of 250 patients who based on a cataract surgery index (CSI) were felt to have less than a 30% probability of reporting improvements in visual functioning after surgery. Cost was estimated using monthly resource utilization surveys and Medicare billing and payment data. Effectiveness was evaluated at 6 months using the Activities of Daily Vision Scale (ADVS) and the Health Utilities Index, Mark 3 (HUI3).

Results: In terms of overall utility, the incremental cost-effectiveness of surgery was Dollars 38,288/QALY. In the subgroup of patients with a CSI score > 11 (< 20% probability of improvement), the cost-effectiveness of cataract surgery was Dollars 53,500/QALY. Sensitivity analysis demonstrated that often this population of patients may not derive a utility benefit with surgery.

Conclusion: Cataract surgery is cost-effective even in a subpopulation of patient with a lower, < 30%, predicted probability of reporting improved visual functioning after surgery. There may be a subgroup of patients, CSI > 11, for whom a strategy of watchful waiting may be equally effective and considerably less expensive.

Publication types

  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Activities of Daily Living
  • Age Factors
  • Aged
  • Aged, 80 and over
  • Algorithms
  • Cataract Extraction / economics*
  • Cost-Benefit Analysis
  • Data Interpretation, Statistical
  • Diagnosis-Related Groups
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Medicare / economics
  • Multivariate Analysis
  • Regression Analysis
  • Surveys and Questionnaires
  • Time Factors
  • Treatment Outcome
  • Vision Tests
  • Vision, Ocular / physiology*
  • Visual Acuity / physiology