Cost-Utility Analysis of Cataract Surgery in Advanced Glaucoma Patients

Purpose: To assess the cost-effectiveness of cataract surgery in advanced glaucoma (AG) patients. Materials and Methods: A total of 93 patients with AG who underwent cataract surgeries were collected prospectively from June 2010 through June 2013 in Shanghai First People's Hospital, Shanghai Jiao Tong University, Shanghai, and were followed up for at least 3 months. A standard phacoemulsification technique was used to remove cataract(s). No complications occurred intraoperatively or postoperatively. Costs associated with surgery were recorded. Utility values of cataract surgery were obtained by using time trade-off method. Quality-adjusted life-years (QALYs) were calculated using the patients' life expectancy at a 3% discounted rate. Incremental cost-utility analysis was performed (compared with no treatment) by calculating the incremental cost-effectiveness ratio (ICER), that is, the mean incremental cost for each QALY. The bootstrap method was used for statistical analysis, and sensitivity analyses were performed to test robustness of the results. Results: The mean incremental cost of cataract surgery was 9876 Chinese yuan (CNY) [1593 US dollar (USD)] [95% confidence interval (CI), 9144-10,570CNY (1475-1705 USD)]. The mean additional QALYs gained were 2.20 (95% CI, 1.85-2.54), and the incremental cost for each additional QALY was 4508CNY (727 USD) [95% CI, 3890-5234CNY (627-844 USD)], far lower than the per capita annual disposable income in Shanghai, 40,188CNY (6482 USD). Conclusion: For AG patients, cataract surgery does help obtain more QALYs and was highly cost effective.