Second-eye cataract surgery in elderly women: a cost-utility analysis conducted alongside a randomized controlled trial

Aim The aim of this study was to evaluate the cost-effectiveness of second-eye cataract surgery for older women with minimal visual dysfunction in the eye to be operated on from a Health and Personal Social Services perspective, compared to waiting list controls who had already undergone first-eye cataract surgery. Methods A cost-utility analysis was undertaken alongside a randomized controlled trial of second-eye cataract surgery in secondary care ophthalmology clinics. A total of 239 women over 70 years old with one unoperated cataract were randomized to cataract surgery (expedited, approximately 4 weeks) or control (routine surgery, 12 months wait). Outcomes were measured in terms of quality-adjusted life years (QALYs), with health-related quality of life estimated using the EuroQol EQ-5D. Results The operated group had costs which were, on average, 646 pound more than the control group (95% confidence interval, 16-1276 pound, P<0.04) and had a mean QALY gain of 0.015 (95% confidence interval, -0.039 to 0.068, P = 0.59) per patient over 1 year. Therefore, the incremental cost-utility ratio was 44 pound 263 over the 1-year trial period. In an analysis modelling costs and benefits over patients' expected lifetime, the incremental cost per QALY was 17 pound 299, under conservative assumptions. Conclusions Second-eye cataract surgery is not likely to be cost-effective in the short term for those with mild visual dysfunction pre-operation. In the long term, second-eye cataract surgery appears to be cost-effective unless carer costs are included. Eye (2010) 24, 276-283; doi: 10.1038/eye.2009.112; published online 15 May 2009