0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address 54.197.87.25. Please contact the publisher to request reinstatement.
Socioeconomics and Health Services |

Use of Global Visual Acuity Data in a Time Trade-off Approach to Calculate the Cost Utility of Cataract Surgery FREE

Van C. Lansingh, MD, PhD; Marissa J. Carter, MA, PhD
[+] Author Affiliations

Author Affiliations: Fundacion Vision, Asuncion, Paraguay (Dr Lansingh); Fundacion Hugo Nano, Buenos Aires, Argentina (Dr Lansingh); and Strategic Solutions, Inc, Cody, Wyoming (Dr Carter).


Section Editor: Paul P. Lee, MD

More Author Information
Arch Ophthalmol. 2009;127(9):1183-1193. doi:10.1001/archophthalmol.2009.113.
Text Size: A A A
Published online

Objective  To determine the cost utility of cataract surgery worldwide using visual acuity (VA) outcomes and utility values determined by the time trade-off (TTO) method.

Data Sources  Some cost data were taken from a previous search conducted for 1995 to 2006 and we searched MEDLINE and Scopus and Google for more recent data (2006 and 2007).

Study Selection  Articles were identified from the literature using “cataract surgery” in combination with the terms outcomeor visual acuity. Additional searches were conducted using individual countries as a term in combination with VA, outcome, or cost. Regression curves were constructed from utility values derived from a TTO study and VA data. Gains in quality-adjusted life-years (QALYs) were calculated based on life expectancy tables from the World Health Organization and discounts of 3% for both cost and benefit. Sensitivity analyses explored the effect of changes in discounting, life expectancy, preoperative VA, and cost.

Data Extraction  If the data were usable, they were kept; otherwise they were discarded.

Data Synthesis  Preoperative VA (logMAR) correlated with increasing gross national income per capita (Pearson correlation coefficient, −0.784; P < .001) and showed that in developing countries preoperative vision is much poorer compared with developed countries. Cost utility data ranged from $3.5 to $834/QALY in developing countries to $159 to $1356/QALY in developed countries. Sensitivity analysis showed that changing life expectancy, VA, and discount rate resulted in moderate changes.

Conclusions  The TTO approach demonstrates that cataract surgery is extremely cost-effective.

Figures in this Article

Although visual impairment due to cataract is not a major issue in developed countries, in developing countries increasing cataract surgery rates to treat backlogs and meet the demands of an aging population are still a challenging problem, despite advances in surgical techniques and the manufacture of low-cost intraocular lenses (IOLs).1

Cost-effectiveness studies can quantify the effect of a treatment in terms of the quality of life from the recipient's point of view, as well as incorporating its cost to individuals or society, and represent one approach to decision making in health care.2,3If comparable methods are used, treatments or interventions can thus be compared and ranked as being more or less cost-effective. When the study uses the concepts of utility and quality-adjusted life-years (QALYs),4it is termed a cost utility study. In brief, QALYs are years of healthy life lived and are calculated from the difference in utility values before and afteran intervention or treatment using a scale in which 1 = perfect health and death = 0, multiplied by the number of years over which the treatment or intervention is effective. So, for example, if the life expectancy of an individual is 10 years at the time of cataract surgery, and the utility values are 0.85 and 0.95 for preoperative and postoperative conditions, respectively, then the number of QALYs gained would be 10 × (0.95 − 0.85) = 1.

In a previous study,5we explored the few cost utility studies that had been conducted in single countries using the time trade-off (TTO) method and self-assessment scales. Using the utility values derived from Busbee et al6and Kobelt et al,7as well as cost data from several other countries, we calculated a range of possible cost utility values for cataract surgery. When generic quality-of-life instruments, such as the 15D8and EQ-5D,7are used to estimate utility values, the changes are relatively small, from 0.01 to 0.03. However, when the TTO approach is used, the utility change is an order of magnitude larger: 0.148 for surgery of the first eye.6

In addition to the different methods one can use to obtain utility values, one must also consider the status of the companion eye. Brown9maintains that the TTO approach to measuring utility better correlates with vision and quality-of-life issues in comparison with self-assessment scales. Furthermore, Brown et al10concluded that a positive utility value change of about 0.08 is obtained when a visually impaired eye is treated for ocular disease, with resultant good visual acuity (VA) for the case in which the companion eye already has good VA. While Busbee et al6included the complications of cataract surgery in their calculation of the utility change associated with cataract surgery of the first eye, because of lack of VA data for the companion eye, they assumed its VA would be the same as the preoperative value for the eye that would receive surgery. However, they have pointed out—and we agree—that the resultant utility gain can be overestimated if the companion eye has good or better vision than the eye to be operated on.

Using TTO-derived utility values for a scale of VA from 20/20 to no light perception in the better-seeing eye,11we investigated the cost utility of cataract surgery using outcome data from dozens of different studies around the world. Our goals of the study were 3-fold: to (1) calculate the cost utility of cataract surgery in both developing and developed countries, (2) estimate the correction to cost utility values obtained in cases in which the VA of the companion eye is substantially different from the operated-on eye, and (3) compare the calculated cost utility values with a variety of benchmarks to assess the cost utility of cataract surgery.

COST

Some cost data for cataract surgery were taken from a previous search conducted for 1995 to 2006.5In addition, we searched MEDLINE and Scopus for more recent data (2006 and 2007) using the terms cost + cataract surgery. Publications written in other languages besides English were not excluded. Additional cost data were uncovered by searching Google using the terms cataract surgery + cost + country(ie, India or Nepal) (eTable 1). However, these data were not used unless they were government data or the publication was authored by a person who had previously published in peer-reviewed ophthalmology or health economics journals.

Costs were first converted to dollars by using Federal Reserve historical foreign exchange rates (www.federalreserve.gov/RELEASES/H10/hist/; accessed November 23, 2007) and then adjusted to 2004 prices by using Consumer Price Index data conversion factors (http://oregonstate.edu/cla/polisci/faculty-research/sahr/infcf17742008.pdf; accessed March 18, 2009).

Although some disagreement exists regarding how much discount must be applied to discount future benefits, we followed the US Panel on Cost-Effectiveness in Health and Medicine recommendation of a 3% discount rate for both costs and benefits.12Costs were thus discounted at 3% based on the life expectancies of individuals in a given country.

GROSS NATIONAL INCOME AND LIFE EXPECTANCY DATA

Gross national income (GNI) per capita for 2004 for each country (Atlas method) was obtained from the World Bank (http://web.worldbank.org; accessed September 12, 2007).

Life expectancies were calculated based on the mean age of each study cohort or cohorts and the year in which the study was conducted, matching the study year as closely as possible to the available years for actuarial tables. Actuarial tables provided by the World Health Organization for 2000 to 2005 (www.who.int/whosis/database/life/life_tables/life_tables.cfm; accessed November 13, 2007) were used to calculate the life expectancy of each study cohort or cohorts using combined sex data. Life expectancies were available in increments of 5 years for the age of individuals, and a regression analysis was performed for life expectancy vs age for each country based on these data to improve accuracy by interpolation. Using mean age of the study cohort as the age parameter and the regression equation for each country, we then calculated the life expectancy.

VA DATA

Pertinent articles on the subject of VA outcome in cataract surgery were identified by searching MEDLINE and Scopus from 1996 to 2007, using the phrase “cataract surgery” in combination with the terms outcomeor visual acuity. Additional searches were conducted for specific countries, using individual countries as a term in combination with “cataract surgery” and “outcome.” Articles were selected on the basis of providing clear VA data (uncorrected or best-corrected) for both preoperative and postoperative groups of patients. In 2 instances, we deviated from this practice because we felt the data were important. For 3 articles dealing with China, we adopted a mean preoperative VA of 3/60, and for Ethiopia, we used the survey data of Melese et al13to calculate a mean preoperative value. For studies that were randomized controlled trials, we combined the data for both groups where possible.

CONVERSION OF VA DATA

Mean visual acuities reported in logMAR units were directly used. If ranges were given, arithmetic means were calculated based on the prevalence for each range. If geometric mean Snellen VA values were reported, these were converted to decimal figures and then logMAR units by inverting the values and calculating the logarithms. If ranges were given, the VA in logMAR units was calculated for each range and the arithmetic mean calculated based on the prevalence given for each range. For the lowest range with an unspecified lowest value (eg, ≤3/60, the definition of blindness), we took the value 0.01 and the value of the specified VA and averaged these values after first converting them to logMAR units. At the high end of the scale, if no upper limit was defined for a preoperative range (eg, >3/60), we added 0.1 Snellen decimal unit to create the upper range and then converted the values to logMAR units before averaging. Thus, in this example (>3/60), the decimal Snellen values would be 0.05 and 0.15. In the case of postoperative values (eg, ≥6/9), we assigned a Snellen decimal value of 1.0 for the upper range.

COST CALCULATIONS

Where several studies of costs were available, these were averaged prior to discounting unless otherwise stated.

For Brazil, the cost of extracapsular cataract extraction (ECCE) was determined by dividing the cost for phacoemulsification by 1.26; this factor was calculated by separately averaging the costs for ECCE and phacoemulsification taken from 5 studies/reports.1418

For China, rural costs were averaged,19,20and this figure was averaged with the provincial cost20to determine the rural cost of cataract surgery. For cataract surgery studies conducted in Chinese cities, such as Hong Kong,21the cost of cataract surgery used the city cost figure from Tan.20

For India, the cost of intracapsular cataract extraction or ECCE in camps (without IOLs) used the costs from Singh et al22(camp provider costs) and was only applied to the studies of Verma et al23and Kapoor et al.24For the Kapoor et al study24(ECCE + IOLs), an additional $10 was added to the basic cost. For the study of Prajna et al,25hospital costs for intracapsular cataract extraction/ECCE were taken from Singh et al22and averaged. However, for the eye camp study of Balent et al26and all other Indian studies, the costs used were averages for ECCE, manual small-incision cataract surgery, and phacoemulsification taken from Muralikrishnan et al15and Gogate et al.27,28

For Singapore, the costs of cataract surgery and the VA outcomes for 1 study (Saw et al29) were adjusted to reflect the percentages of phacoemulsification and ECCE used.

CALCULATION OF COST UTILITY

Using the utility data for VA reported by Brown et al,11a regression analysis was performed and a third-order polynomial equation was fitted to the VA data on a log-linear scale (Figure 1). Details of this equation and the one used to calculate cost utility are found in eTable 2.

Place holder to copy figure label and caption
Figure 1.

Regression line (third-order polynomial) for fitting utility results to visual acuity (logMAR) on a log-linear plot, using data from Brown et al.11

Graphic Jump Location
ESTIMATION OF UTILITY GAIN USING VA DATA FROM OPERATED-ON AND COMPANION EYES

While utility values better correlate with VA in the better-seeing eye,30the majority of data available for VA outcomes of cataract surgery are for the operated-on eye. If the difference in VA between the operated-on eye and the companion eye is substantial, there is likely to be an error in using the utility value based on the preoperative VA of the operated-on eye. This error leads to a larger change in utility values from cataract surgery than would be expected if the VA of the companion eye had been used as the basis for the calculation. An estimate of this error was obtained by comparing 2 scenarios: (1) change in utility using the worse-eye preoperative and postoperative VA data and (2) change in utility using the preoperative VA of the companion eye and the postoperative VA of the operated-on eye in 5 cataract surgery studies in which data were available for each eye.7,3134

SENSITIVITY ANALYSIS

To explore the robustness of our methods, using the base case of 3% discounting (costs and QALYs gained), we examined the effect of changing the following variables: life expectancy (±2.5 years); change in decimal VA (±10%); discount rate (0%-5%); and additional costs (cost +25%, 3-fold increase in costs).

COMPUTATIONS AND STATISTICS

All computations were carried out using Excel (Microsoft, Redmond, Washington). Correlations were calculated using SPSS v.16 (SPSS Inc, Chicago, Illinois). A Pvalue of <.05 was considered statistically significant.

COSTS AND VA

Undiscounted costs are shown in Table 1by country. Preoperative and postoperative VA data, together with descriptions of the type of surgery performed, number of eyes in each study, and other remarks, are shown in Table 2, also by country. The number of eyes in each study was taken from postoperative data because this number was usually smaller than the number for preoperative data. When preoperative and postoperative VA data were plotted against GNI per capita for each study and its respective country, the preoperative VA showed a definite trend toward better vision with increasing GNI per capita (Pearson correlation coefficient, −0.784; P < .001), but the postoperative VA showed a correlation line with a smaller slope (Pearson correlation coefficient, −0.572; P = .005) (Figure 2). Among developing countries, the largest differences between preoperative and postoperative VAs were found for Kenya and Uganda, while the smallest differences were found for China and Ethiopia (Figure 3). Among developed nations, the largest differences were found for Malaysia, Spain, and New Zealand, while the smallest differences were found for Australia, Finland, and the United Kingdom (Figure 4).

Place holder to copy figure label and caption
Figure 2.

Preoperative and postoperative visual acuity (VA) vs gross national product (GNP) per capita for each study. Solid and dashed lines were fitted to postoperative and preoperative VA, respectively, using linear regression.

Graphic Jump Location
Place holder to copy figure label and caption
Figure 3.

Preoperative and postoperative visual acuity (VA) by country for developing countries.

Graphic Jump Location
Place holder to copy figure label and caption
Figure 4.

Preoperative and postoperative visual acuity (VA) by country for developed countries.

Graphic Jump Location
Table Graphic Jump LocationTable 1. Costs of Cataract Surgery for the First Eye Calculated for Different Countries
Table Graphic Jump LocationTable 2. Preoperative and Postoperative VA and Mean Changesa(continued)
COST UTILITY

For developed countries, undiscounted mean utility gains (unweighted with respect to number of eyes in each study) ranged from 0.108 in the United Kingdom to 0.217 in New Zealand. In developing countries, the range was from 0.059 in Ethiopia to 0.274 in Kenya, with a mean of 0.196 for India. The mean utility gain for developed countries (0.159) was less than that for developing countries (0.190).

Cost utility values ranged from $3.5 to $834/QALY in developing countries to $159 to $1356/QALY in developed countries (Table 3). Among developing countries, 1 study in China showed the smallest QALY gain (0.381) while the largest was for 1 study in Nepal (3.042 QALYs); QALY gains in India ranged from 0.645 to 2.911. Among the developed countries, the largest QALY gain was found in Germany (2.369) and the smallest, in 1 UK study (0.618).

Table Graphic Jump LocationTable 3. Cost Utility Expressed as Cost per QALYa

In the developing world, China and Brazil had the highest cost utility values, while Nepal and India had the lowest values. In developed countries, Australia, Finland, and the United States had the highest cost utility values while cost utility values were the lowest in Canada.

SENSITIVITY ANALYSIS

The results of calculating utility gains from operated-on vs companion eyes showed that the greater the difference in VA between the operated-on and companion eye, the more the apparent utility gain overestimated the true utility gain (Figure 5).

Place holder to copy figure label and caption
Figure 5.

Linear regression plot of difference between preoperative visual acuity (VA) of operated-on and companion eyes and difference between apparent utility gain (calculated using preoperative operated-on eye VA data) and true utility gain (calculated using preoperative companion eye VA data). The horizontal bar represents maximum possible utility gain estimated from second-eye cataract surgery when the first eye has normal sight (Brown et al10).

Graphic Jump Location

The sensitivity analysis showed that changing life expectancy, the postoperative VA resulting from cataract surgery, and the discount rate all resulted in moderate changes (Table 4). Although most economists accept the need for discounting future benefits, controversy still exists regarding the rate and whether that rate should be different for costs and health benefits.8486The effect of discounting compared with no discounting reduced cost utility figures by 31% and 20% for discounts of 5% and 3%, respectively. Increasing life expectancy by 2.5 years reduced cost utility by 18%.

Our first goal in this study was to estimate the cost utility for patients undergoing cataract surgery by using a combination of VA outcomes from many different countries and utility values obtained using a TTO approach. As expected, undiscounted utility gains were consistently larger in the majority of cases compared with the utility difference of 0.08 reported by Brown et al,10which estimates the utility of second-eye surgery. Busbee et al6modeled utility gains for first-eye cataract surgery from the US arm of the US National Cataract Patient Outcomes Research Team study using both VA data and surgical complications encountered 4 months postsurgery and assumed that the VA of the companion eye was the same as the operated-on eye. Their utility gain of 0.148 is similar to the mean utility gain we calculated (0.141) by averaging the data for the 4 US studies reported in Table 3.

In a previous study,5we showed that cost utility studies of cataract surgery varied more than an order of magnitude when generic quality-of-life instruments, such as the 15D7and EQ-5D,8were compared with the TTO approach. The reason is that much smaller changes in utility values are reported by patients in comparison with the TTO approach. This raises the question: Which is the more valid method? Although there are no definitive data that will answer this question, a study conducted by Badia et al87showed that while the visual analog scales used in the EQ-5D were easier and slightly more reliable than the TTO approach, the TTO approach was more likely to better discriminate between health states and may have greater construct validity. In addition, other instruments that have been used to measure visual disability, including cataract, have been recently criticized on the basis of Rasch analysis, because suboptimal scaling can produce misleading results.88

When we compared cost utility for the 4 developing countries from our previous study7(Brazil, India, Malaysia, and Nepal) with the corresponding countries in this study, in 3 of the countries (Brazil, Malaysia, and Nepal), the cost utilities of cataract surgery were substantially less in this study. In the case of India, the average cost utility was slightly higher in this study than the lowest range for India in the previous study.5These differences suggest a lower cost utility using the combination of VA outcomes and the TTO approach in comparison with the generic instrument approach. However, using the TTO approach adopted in this study requires adjustment for the fact that utility correlates better with the better-seeing eye, and our crude estimates (Figure 5) suggest this factor is relatively small when the preoperative VA difference between the worse-seeing and better-seeing eye is small (for example, between 6/60 and 20/60) but is comparatively large for larger differences (for example, between 10/60 and 40/60). We do not know if the difference between apparent and true utility gain for first-eye surgery as we have calculated it continues to increase beyond a certain point. However, the limited data suggest that, on average, true cost utility is approximately double that calculated using preoperative and postoperative VA data from the operated-on eye.

Our findings also confirm that preoperative VA is much better in developed countries compared with developing countries, using GNI per capita as the separating factor. However, the difference in postoperative VA values between countries is much smaller, suggesting that, on average, the outcomes of cataract surgery in developing countries are starting to approach those in developed countries (Figure 3). In terms of cost utility, this means that for cataract surgery, a high threshold of VA (poorer preoperative vision) will ensure a more cost-effective intervention.

In this study, we used life expectancy tables for each country matched as closely as possible to the year the cataract surgery study was undertaken, using the mean age of the study cohort as the reference age for starting the benefit. This approach provides the most accurate results possible, since duration of cataract surgery is expected to last over the remaining years of the patient.89Over the next 10 to 15 years, patients may be expected to live longer in developing countries, and thus, the cost utility of cataract surgery ought to increase, but against this change, one must consider the possibility that the threshold VA at which cataract surgery is performed may also increase, as has happened in developed countries. For example, our analysis showed that an increase of 10% in preoperative VA (better vision) and 10% decrease in postoperative VA (poorer outcome) increased cost utility by 26%. Conversely, if surgery in developing countries is improved so that the postoperative VA is increased by 10%, considerable gains in cost utility are possible.

The costs used in our studies generally covered only the costs of basic surgery provided by the private, government, or nongovernment organization carrying out the surgery (ie, provider costs, proportional facility overheads, IOL cost, anesthesia costs, postoperative medicine costs, and cost of 1 follow-up visit); they do not include costs of complications or adverse events or out-of-pocket expenses, especially costs related to healing and caregiving. However, the cost basis in some developing countries is very difficult to ascertain and thus may not be comparable with those from the countries in which the costs are meticulously specified.

For example, average costs (undiscounted) incurred by cataract surgery alone in the United Kingdom were about $620 in 2004 dollars. However, a comprehensive cost analysis carried out by Sach et al90demonstrated that the cost difference between the control and experimental arms of their randomized controlled trial of cataract surgery was £2004 in 2006, which equates to $3461 in 2004 dollars. This cost is approximately 5.6 times the figure of $620. In developing countries, we do not know what the comparable differential is since there is a paucity of data on this subject, although it might be less compared with developed countries, as many of the factors that go into detailed cost calculations will likely be absent.

The World Health Organization has suggested benchmarks for the cost-effectiveness of interventions based on regions.91When the cost-effectiveness value is below the gross domestic product per capita, the intervention is considered very cost-effective; values of 1 to 3 times the gross domestic product are considered cost-effective, and values more than 3 times the gross domestic product are not considered cost-effective. On this basis, the cost utility of cataract surgery in all the developing countries analyzed in this study easily meets the World Health Organization definition of very cost-effective, no matter how it is calculated, in many instances by a large margin.

There are limitations to our study. Calculations of cost utility were predicated on accurate costs and VA data and the quality of both varied considerably in the studies we used. For some countries, such as India, where there was a wealth of data, averaging the results from many studies will tend to provide more accurate estimates for the country as a whole. However, there is likely to be more error in the case of a single study used to represent 1 country. In addition, the development of correction factors to account for the poorer correlation of VA data with utility values in the worse-seeing eye was based on data from only a few studies, with errors that are hard to estimate. Last, we focused on direct cataract surgery costs because there is little information available on other costs in developing countries. The realistic cost utility of cataract surgery is therefore higher (eg, cost per QALY gained) than we have presented, although we do not believe this materially affects our conclusions. On the other hand, the strengths of our study include the fact that we used a regression equation to derive utility values from VA data and local life expectancy tables to estimate the length of benefit duration. Further, we have explored as many variables as possible to determine their likely impact on cost utility.

Correspondence: Marissa J. Carter, MA, PhD, Strategic Solutions, Inc, 1143 Salsbury Ave, Cody, WY 82414 (mcarter@strategic-solutions-inc.com).

Submitted for Publication: June 19, 2008; final revision received October 30, 2008; accepted November 11, 2008.

Author Contributions: Dr Carter had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Financial Disclosure: None reported.

Yorston  D High-volume surgery in developing countries. Eye 2005;19 (10) 1083- 1089
PubMed
Brown  MMBrown  GC How to interpret a healthcare economic analysis. Curr Opin Ophthalmol 2005;16 (3) 191- 194
PubMed
Smith  AFBrown  GC Understanding cost effectiveness: a detailed review. Br J Ophthalmol 2000;84 (7) 794- 798
PubMed
Arnesen  TNord  E The value of DALY life: problems with ethics and validity of disability adjusted life years. BMJ 1999;319 (7222) 1423- 1425
PubMed
Lansingh  VCCarter  MJMartens  M Global cost-effectiveness of cataract surgery. Ophthalmology 2007;114 (9) 1670- 1678
PubMed
Busbee  BGBrown  MMBrown  GCSharma  S Incremental cost-effectiveness of initial cataract surgery. Ophthalmology 2002;109 (3) 606- 612, discussion 612-613
PubMed
Kobelt  GLundstrom  MStenevi  U Cost-effectiveness of cataract surgery: method to assess cost-effectiveness using registry data. J Cataract Refract Surg 2002;28 (10) 1742- 1749
PubMed
Räsänen  PKrootila  KSintonen  H  et al.  Cost-utility of routine cataract surgery. Health Qual Life Outcomes 2006;474
PubMed
Brown  GC Vision and quality-of-life. Trans Am Ophthalmol Soc 1999;97473- 511
PubMed
Brown  MMBrown  GCSharma  SBusbee  BBrown  H Quality of life associated with unilateral and bilateral good vision. Ophthalmology 2001;108 (4) 643- 647, discussion 647-648
PubMed
Brown  MMBrown  GCSharma  SLandy  J Health care economic analyses and value-based medicine. Surv Ophthalmol 2003;48 (2) 204- 223
PubMed
Weinstein  MCSiegel  JEGold  MRKamlet  MSRussell  LB Recommendations of the Panel on Cost-effectiveness in Health and Medicine. JAMA 1996;276 (15) 1253- 1258
PubMed
Melese  MAlemayehu  WBayu  S  et al.  Low vision and blindness in adults in Gurage Zone, central Ethiopia. Br J Ophthalmol 2003;87 (6) 677- 680
PubMed
Asimakis  PCoster  DJLewis  DJ Cost effectiveness of cataract surgery: a comparison of conventional extracapsular surgery and phacoemulsification at Flinders Medical Centre. Aust N Z J Ophthalmol 1996;24 (4) 319- 325
PubMed
Muralikrishnan  RVenkatesh  RPrajna  NVFrick  KD Economic cost of cataract surgery procedures in an established eye care centre in Southern India. Ophthalmic Epidemiol 2004;11 (5) 369- 380
PubMed
Loo  CYKandiah  MArumugam  G  et al.  Cost efficiency and cost effectiveness of cataract surgery at the Malaysian Ministry of Health ophthalmic services. Int Ophthalmol 2004;25 (2) 81- 87
PubMed
Rizal  AMAljunid  SMNormalina  M  et al.  Cost analysis of cataract surgery with intraocular lens implantation: a single blind randomised clinical trial comparing extracapsular cataract extraction and phacoemulsification. Med J Malaysia 2003;58 (3) 380- 386
PubMed
Ganesan  G Cataract surgery: volumes, costs and outcomes. MOH information paper 2006/012. http://www.moh.gov.sg/mohcorp/uploadedFiles/Publications/Information_Papers/2006/OP_on_Cataract.pdf. Published 2006. Accessed October 23, 2007
He  MChan  VBaruwa  EGilbert  DFrick  KDCongdon  N Willingness to pay for cataract surgery in rural Southern China. Ophthalmology 2007;114 (3) 411- 416
PubMed
Tan  L Increasing the volume of cataract surgery: an experience in rural China. Community Eye Health 2006;19 (60) 61- 63
PubMed
Lau  JMichon  JJChan  WSEllwein  LB Visual acuity and quality of life outcomes in cataract surgery patients in Hong Kong. Br J Ophthalmol 2002;86 (1) 12- 17
PubMed
Singh  AJGarner  PFloyd  K Cost-effectiveness of public-funded options for cataract surgery in Mysore, India. Lancet 2000;355 (9199) 180- 184
PubMed
Verma  LGupta  SKMurthy  GVGoyal  MPant  TD A follow-up study on visual outcome after camp-based intracapsular cataract extraction. Trop Med Int Health 1996;1 (3) 342- 347
PubMed
Kapoor  HChatterjee  ADaniel  RFoster  A Evaluation of visual outcome of cataract surgery in an Indian eye camp. Br J Ophthalmol 1999;83 (3) 343- 346
PubMed
Prajna  NVChandrakanth  KSKim  R  et al.  The Madurai Intraocular Lens Study, II: clinical outcomes. Am J Ophthalmol 1998;125 (1) 14- 25
PubMed
Balent  LCNarendrum  KPatel  SKar  SPatterson  DA High volume sutureless intraocular lens surgery in a rural eye camp in India. Ophthalmic Surg Lasers 2001;32 (6) 446- 455
PubMed
Gogate  PMDeshpande  MWormald  RP Is manual small incision cataract surgery affordable in the developing countries? A cost comparison with extracapsular cataract extraction. Br J Ophthalmol 2003;87 (7) 843- 846
PubMed
Gogate  PDeshpande  MNirmalan  PK Why do phacoemulsification? Manual small-incision cataract surgery is almost as effective, but less expensive. Ophthalmology 2007;114 (5) 965- 968
PubMed
Saw  SMTseng  PChan  WKChan  TKOng  SGTan  D Visual function and outcomes after cataract surgery in a Singapore population. J Cataract Refract Surg 2002;28 (3) 445- 453
PubMed
Brown  MMBrown  GCSharma  SSmith  AFLandy  J A utility analysis correlation with visual acuity: methodologies and vision in the better and poorer eyes. Int Ophthalmol 2001;24 (3) 123- 127
PubMed
Sarikkola  AUKontkanen  MKivela  TLaatikainen  L Simultaneous bilateral cataract surgery: a retrospective survey. J Cataract Refract Surg 2004;30 (6) 1335- 1341
PubMed
Johansson  BALundh  BL Bilateral same day phacoemulsification: 220 cases retrospectively reviewed. Br J Ophthalmol 2003;87 (3) 285- 290
PubMed
Castells  XAlonso  JCastilla  MRibó  CCots  FAntó  JM Outcomes and costs of outpatient and inpatient cataract surgery: a randomised clinical trial. J Clin Epidemiol 2001;54 (1) 23- 29
PubMed
Lundström  MAlbrecht  SNilsson  MÅström  B Benefit to patients of bilateral same-day cataract extraction: randomized clinical study. J Cataract Refract Surg 2006;32 (5) 826- 830
PubMed
Fan  YPBoldy  DBowen  D Comparing patient satisfaction, outcomes and costs between cataract day surgery and inpatient surgery for elderly people. Aust Health Rev 1997;20 (4) 27- 39
PubMed
Saad Filho  RSaad  FGFreitas  LL Cost of phacoemulsification in the national campaign of elective cataract surgery in Itapolis, SP, Brazil [article in Portuguese]. Arq Bras Oftalmol 2005;68 (1) 55- 59
PubMed
Chen  SArshinoff  S A cost-analysis of unilateral vs. simultaneous bilateral surgery in Canada. Clin Surg Ophthalmol 2005;23324- 332
Lin  Y Comparative study on preventing avoidable blindness in China and in Nepal. Chin Med J (Engl) 2007;120 (4) 280- 283
PubMed
Anderson  GBlack  CDunn  E  et al.  Willingness to pay to shorten waiting time for cataract surgery. Health Aff (Millwood) 1997;16 (5) 181- 190
PubMed
Melese  MAlemayehu  WFriedlander  ECourtright  P Indirect costs associated with accessing eye care services as a barrier to service use in Ethiopia. Trop Med Int Health 2004;9 (3) 426- 431
PubMed
Orme  MEPaine  ACTeale  CWKennedy  LM Cost-effectiveness of the AMOArray multifocal intraocular lens in cataract surgery. J Refract Surg 2002;18 (2) 162- 168
PubMed
Landwehr  ITehrani  MDick  HBKrummenauer  F Cost effectiveness evaluation of cataract patient care in respect of monofocal intraocular lenses from the perspective of German statutory health insurance [article in German]. Klin Monatsbl Augenheilkd 2003;220 (8) 532- 539
PubMed
Pagel  NDick  HBKrummenauer  F Incremental cost effectiveness of multifocal cataract surgery [article in German]. Klin Monatsbl Augenheilkd 2007;224 (2) 101- 109
PubMed
Shmueli  AIntrator  OIsraeli  A The effects of introducing prospective payments to general hospitals on length of stay, quality of care, and hospitals' income: the early experience of Israel. Soc Sci Med 2002;55 (6) 981- 989
PubMed
Lewallen  SEliah  EGilbert  S The cost of outreach services in eastern Africa. IAPB News. 2006; ((50)) 16- 17http://www.iapb.org/newsletters/50_august-newsletter-2006.pdf. Accessed November 2, 2007
Marseille  E Cost-effectiveness of cataract surgery in a public health eye care programme in Nepal. Bull World Health Organ 1996;74 (3) 319- 324
PubMed
Marseille  EGilbert  S The cost of cataract surgery in a public health eye care program in Nepal. Health Policy 1996;35 (2) 145- 154
PubMed
Ruit  STabin  GCNissman  SAPaudyal  GGurung  R Low-cost high-volume extracapsular cataract extraction with posterior chamber intraocular lens implantation in Nepal. Ophthalmology 1999;106 (10) 1887- 1892
PubMed
King  A $17 million for extra cataract operations. http://www.beehive.govt.nz/?q=node/22876. Published May 3, 2005. Accessed November 12, 2007
Osahon  AI Cataract surgery output and cost of hospitalization for cataract surgery in the University of Benin Teaching Hospital. West Afr J Med 2002;21 (3) 174- 176
PubMed
Lundström  MBrege  KGFloren  IRoos  PStenevi  UThorburn  W Cataract surgery and effectiveness, 1: variation in costs between different providers of cataract surgery. Acta Ophthalmol Scand 2000;78 (3) 335- 339
PubMed
Minassian  DCRosen  PDart  JK  et al.  Extracapsular cataract extraction compared with small incision surgery by phacoemulsification: a randomised trial. Br J Ophthalmol 2001;85 (7) 822- 829
PubMed
Afsar  AJWoods  RLPate  SRogan  FWykes  W Economic costs of cataract surgery using a rigid and a foldable intraocular lens. Ophthalmic Physiol Opt 2001;21 (4) 262- 267
PubMed
Naeim  AKeeler  EBGutierrez  PRWilson  MRReuben  DMangione  CM Is cataract surgery cost-effective among older patients with a low predicted probability for improvement in reported visual functioning? Med Care 2006;44 (11) 982- 989
PubMed
Rein  DBZhang  PWirth  KE  et al.  The economic burden of major adult visual disorders in the United States. Arch Ophthalmol 2006;124 (12) 1754- 1760
PubMed
Pager  CK McCluskey  PJRetsas  C Cataract surgery in Australia: a profile of patient-centered outcomes. Clin Experiment Ophthalmol 2004;32 (4) 388- 392
PubMed
Kirkwood  BJPesudovs  KLatimer  PCoster  DJ The efficacy of a nurse-led preoperative cataract assessment and postoperative care clinic. Med J Aust 2006;184 (6) 278- 281
PubMed
Nascimento  MALira  RPSoares  PHSpessatto  NKara-José  NArieta  CE Are routine preoperative medical tests needed with cataract surgery? Study of visual acuity outcome. Curr Eye Res 2004;28 (4) 285- 290
PubMed
Norregaard  JCHindsberger  CAlonso  J  et al.  Visual outcomes of cataract surgery in the United States, Canada, Denmark, and Spain: report from the International Cataract Surgery Outcomes Study. Arch Ophthalmol 1998;116 (8) 1095- 1100
PubMed
Norregaard  JCBernth-Petersen  PAlonso  JAndersen  TFAnderson  GF Visual functional outcomes of cataract surgery in the United States, Canada, Denmark, and Spain: report of the International Cataract Surgery Outcomes Study. J Cataract Refract Surg 2003;29 (11) 2135- 2142
PubMed
Noertjojo  KMildon  DRollins  D  et al.  Cataract surgical outcome at the Vancouver Eye Care Centre: can it be predicted using current data? Can J Ophthalmol 2004;39 (1) 38- 47
PubMed
He  MXu  JLi  SWu  KMunoz  SREllwein  LB Visual acuity and quality of life in patients with cataract in Doumen County, China. Ophthalmology 1999;106 (8) 1609- 1615
PubMed
Bassett  KLNoertjojo  KLiu  L  et al.  Cataract surgical coverage and outcome in the Tibet Autonomous Region of China. Br J Ophthalmol 2005;89 (1) 5- 9
PubMed
Zerihun  N Visual outcome of the first 500 cataract extractions done in the field; Jimma, Ethiopia. Int Ophthalmol 2001;24 (5) 291- 295
PubMed
Kohnen  SFerrer  ABrauweiler  P Visual function in pseudophakic eyes with poly(methyl methacrylate), silicone, and acrylic intraocular lenses. J Cataract Refract Surg 1996;22 ((suppl 2)) 1303- 1307
PubMed
Dandona  LDandona  RAnand  RSrinivas  MRajashekar  V Outcome and number of cataract surgeries in India: policy issues for blindness control. Clin Experiment Ophthalmol 2003;31 (1) 23- 31
PubMed
Gogate  PMDeshpande  MWormald  RPDeshpande  RKulkarni  SR Extracapsular cataract surgery compared with manual small incision cataract surgery in community eye care setting in western India: a randomised controlled trial. Br J Ophthalmol 2003;87 (6) 667- 672
PubMed
Mamidipudi  PRVasavada  ARMerchant  SVNamboodiri  VRavilla  TD Quality-of-life and visual function assessment after phacoemulsification in an urban Indian population. J Cataract Refract Surg 2003;29 (6) 1143- 1151
PubMed
Venkatesh  RMuralikrishnan  RBalent  LCPrakash  SKPrajna  NV Outcomes of high volume cataract surgeries in a developing country. Br J Ophthalmol 2005;89 (9) 1079- 1083
PubMed
Leshno  MReuveni  H Inappropriateness of cataract extraction: an analysis in two Israeli hospital settings. Clin Perform Qual Health Care 1999;7 (1) 23- 27
PubMed
Yorston  DGichuhi  SWood  MFoster  A Does prospective monitoring improve cataract surgery outcomes in Africa? Br J Ophthalmol 2002;86 (5) 543- 547
PubMed
Hennig  AKumar  JYorston  DFoster  A Sutureless cataract surgery with nucleus extraction: outcome of a prospective study in Nepal. Br J Ophthalmol 2003;87 (3) 266- 270
PubMed
Ruit  STabin  GChang  D  et al.  A prospective randomized clinical trial of phacoemulsification vs manual sutureless small-incision extracapsular cataract surgery in Nepal. Am J Ophthalmol 2007;143 (1) 32- 38
PubMed
Riley  AFMalik  TYGrupcheva  CNFisk  MJCraig  JP McGhee  CN The Auckland cataract study: co-morbidity, surgical techniques, and clinical outcomes in a public hospital service. Br J Ophthalmol 2002;86 (2) 185- 190
PubMed
Alhassan  MBKyari  FAchi  IBOzemela  CPAbiose  A Audit of outcome of an extracapsular cataract extraction and posterior chamber intraocular lens training course. Br J Ophthalmol 2000;84 (8) 848- 851
PubMed
Wang  JCTan  AWMonatosh  RChew  PT Experience with ARRAY multifocal lenses in a Singapore population. Singapore Med J 2005;46 (11) 616- 620
PubMed
Waddell  KMReeves  BCJohnson  GJ A comparison of anterior and posterior chamber lenses after cataract extraction in rural Africa: a within patient randomised trial. Br J Ophthalmol 2004;88 (6) 734- 739
PubMed
Desai  PMinassian  DCReidy  A National cataract surgery survey 1997-8: a report of the results of the clinical outcomes. Br J Ophthalmol 1999;83 (12) 1336- 1340
PubMed
Tinley  CGFrost  AHakin  KN McDermott  WEwings  P Is visual outcome compromised when next day review is omitted after phacoemulsification surgery? A randomised control trial. Br J Ophthalmol 2003;87 (11) 1350- 1355
PubMed
Zaidi  FHCorbett  MCBurton  BJBloom  PA Raising the benchmark for the 21st century—the 1000 cataract operations audit and survey: outcomes, consultant-supervised training and sourcing NHS choice. Br J Ophthalmol 2007;91 (6) 731- 736
PubMed
Lum  FSchein  OSchachat  APAbbott  RLHoskins  HD  JrSteinberg  EP Initial two years of experience with the AAO National Eyecare Outcomes Network (NEON) cataract surgery database. Ophthalmology 2000;107 (4) 691- 697
PubMed
Tobacman  JKZimmerman  BLee  PHilborne  LKolder  HBrook  RH Visual acuity following cataract surgeries in relation to preoperative appropriateness ratings. Med Decis Making 2003;23 (2) 122- 130
PubMed
Killestein  JHillegers  Mvan der Windt  CStilma  JS Outcome of cataract surgery by a general medical doctor at district level, Zimbabwe: a retrospective follow-up study. Int Ophthalmol 1996-1997;20 (5) 279- 283
PubMed
Brouwer  WBNiessen  LWPostma  MJRutten  FF Need for differential discounting of costs and health effects in cost effectiveness analyses. BMJ 2005;331 (7514) 446- 448
PubMed
Claxton  KSculpher  MCulyer  A  et al.  Discounting and cost-effectiveness in NICE—stepping back to sort out a confusion. Health Econ 2006;15 (1) 1- 4
PubMed
Bos  JMPostma  MJAnnemans  L Discounting health effects in pharmacoeconomic evaluations: current controversies. Pharmacoeconomics 2005;23 (7) 639- 649
PubMed
Badia  XMonserrat  SRoset  MHerdman  M Feasibility, validity and test-retest reliability of scaling methods for health states: the visual analogue scale and the time trade-off. Qual Life Res 1999;8 (4) 303- 310
PubMed
Pesudovs  KGaramendi  EKeeves  JPElliott  DB The Activities of Daily Vision Scale for cataract surgery outcomes: re-evaluating validity with Rasch analysis. Invest Ophthalmol Vis Sci 2003;44 (7) 2892- 2899
PubMed
Lundström  MWendel  E Duration of self assessed benefit of cataract extraction: a long term study. Br J Ophthalmol 2005;89 (8) 1017- 1020
PubMed
Sach  THFoss  AJGregson  RM  et al.  Falls and health status in elderly women following first eye cataract surgery: an economic evaluation conducted alongside a randomised controlled trial. Br J Ophthalmol 2007;91 (12) 1675- 1679
PubMed
World Health Organization, Cost effectiveness thresholds. http://www.who.int/choice/costs/CER_thresholds/en/index.html. Accessed May 20, 2008

Figures

Place holder to copy figure label and caption
Figure 1.

Regression line (third-order polynomial) for fitting utility results to visual acuity (logMAR) on a log-linear plot, using data from Brown et al.11

Graphic Jump Location
Place holder to copy figure label and caption
Figure 2.

Preoperative and postoperative visual acuity (VA) vs gross national product (GNP) per capita for each study. Solid and dashed lines were fitted to postoperative and preoperative VA, respectively, using linear regression.

Graphic Jump Location
Place holder to copy figure label and caption
Figure 3.

Preoperative and postoperative visual acuity (VA) by country for developing countries.

Graphic Jump Location
Place holder to copy figure label and caption
Figure 4.

Preoperative and postoperative visual acuity (VA) by country for developed countries.

Graphic Jump Location
Place holder to copy figure label and caption
Figure 5.

Linear regression plot of difference between preoperative visual acuity (VA) of operated-on and companion eyes and difference between apparent utility gain (calculated using preoperative operated-on eye VA data) and true utility gain (calculated using preoperative companion eye VA data). The horizontal bar represents maximum possible utility gain estimated from second-eye cataract surgery when the first eye has normal sight (Brown et al10).

Graphic Jump Location

Tables

Table Graphic Jump LocationTable 1. Costs of Cataract Surgery for the First Eye Calculated for Different Countries
Table Graphic Jump LocationTable 2. Preoperative and Postoperative VA and Mean Changesa(continued)
Table Graphic Jump LocationTable 3. Cost Utility Expressed as Cost per QALYa

References

Yorston  D High-volume surgery in developing countries. Eye 2005;19 (10) 1083- 1089
PubMed
Brown  MMBrown  GC How to interpret a healthcare economic analysis. Curr Opin Ophthalmol 2005;16 (3) 191- 194
PubMed
Smith  AFBrown  GC Understanding cost effectiveness: a detailed review. Br J Ophthalmol 2000;84 (7) 794- 798
PubMed
Arnesen  TNord  E The value of DALY life: problems with ethics and validity of disability adjusted life years. BMJ 1999;319 (7222) 1423- 1425
PubMed
Lansingh  VCCarter  MJMartens  M Global cost-effectiveness of cataract surgery. Ophthalmology 2007;114 (9) 1670- 1678
PubMed
Busbee  BGBrown  MMBrown  GCSharma  S Incremental cost-effectiveness of initial cataract surgery. Ophthalmology 2002;109 (3) 606- 612, discussion 612-613
PubMed
Kobelt  GLundstrom  MStenevi  U Cost-effectiveness of cataract surgery: method to assess cost-effectiveness using registry data. J Cataract Refract Surg 2002;28 (10) 1742- 1749
PubMed
Räsänen  PKrootila  KSintonen  H  et al.  Cost-utility of routine cataract surgery. Health Qual Life Outcomes 2006;474
PubMed
Brown  GC Vision and quality-of-life. Trans Am Ophthalmol Soc 1999;97473- 511
PubMed
Brown  MMBrown  GCSharma  SBusbee  BBrown  H Quality of life associated with unilateral and bilateral good vision. Ophthalmology 2001;108 (4) 643- 647, discussion 647-648
PubMed
Brown  MMBrown  GCSharma  SLandy  J Health care economic analyses and value-based medicine. Surv Ophthalmol 2003;48 (2) 204- 223
PubMed
Weinstein  MCSiegel  JEGold  MRKamlet  MSRussell  LB Recommendations of the Panel on Cost-effectiveness in Health and Medicine. JAMA 1996;276 (15) 1253- 1258
PubMed
Melese  MAlemayehu  WBayu  S  et al.  Low vision and blindness in adults in Gurage Zone, central Ethiopia. Br J Ophthalmol 2003;87 (6) 677- 680
PubMed
Asimakis  PCoster  DJLewis  DJ Cost effectiveness of cataract surgery: a comparison of conventional extracapsular surgery and phacoemulsification at Flinders Medical Centre. Aust N Z J Ophthalmol 1996;24 (4) 319- 325
PubMed
Muralikrishnan  RVenkatesh  RPrajna  NVFrick  KD Economic cost of cataract surgery procedures in an established eye care centre in Southern India. Ophthalmic Epidemiol 2004;11 (5) 369- 380
PubMed
Loo  CYKandiah  MArumugam  G  et al.  Cost efficiency and cost effectiveness of cataract surgery at the Malaysian Ministry of Health ophthalmic services. Int Ophthalmol 2004;25 (2) 81- 87
PubMed
Rizal  AMAljunid  SMNormalina  M  et al.  Cost analysis of cataract surgery with intraocular lens implantation: a single blind randomised clinical trial comparing extracapsular cataract extraction and phacoemulsification. Med J Malaysia 2003;58 (3) 380- 386
PubMed
Ganesan  G Cataract surgery: volumes, costs and outcomes. MOH information paper 2006/012. http://www.moh.gov.sg/mohcorp/uploadedFiles/Publications/Information_Papers/2006/OP_on_Cataract.pdf. Published 2006. Accessed October 23, 2007
He  MChan  VBaruwa  EGilbert  DFrick  KDCongdon  N Willingness to pay for cataract surgery in rural Southern China. Ophthalmology 2007;114 (3) 411- 416
PubMed
Tan  L Increasing the volume of cataract surgery: an experience in rural China. Community Eye Health 2006;19 (60) 61- 63
PubMed
Lau  JMichon  JJChan  WSEllwein  LB Visual acuity and quality of life outcomes in cataract surgery patients in Hong Kong. Br J Ophthalmol 2002;86 (1) 12- 17
PubMed
Singh  AJGarner  PFloyd  K Cost-effectiveness of public-funded options for cataract surgery in Mysore, India. Lancet 2000;355 (9199) 180- 184
PubMed
Verma  LGupta  SKMurthy  GVGoyal  MPant  TD A follow-up study on visual outcome after camp-based intracapsular cataract extraction. Trop Med Int Health 1996;1 (3) 342- 347
PubMed
Kapoor  HChatterjee  ADaniel  RFoster  A Evaluation of visual outcome of cataract surgery in an Indian eye camp. Br J Ophthalmol 1999;83 (3) 343- 346
PubMed
Prajna  NVChandrakanth  KSKim  R  et al.  The Madurai Intraocular Lens Study, II: clinical outcomes. Am J Ophthalmol 1998;125 (1) 14- 25
PubMed
Balent  LCNarendrum  KPatel  SKar  SPatterson  DA High volume sutureless intraocular lens surgery in a rural eye camp in India. Ophthalmic Surg Lasers 2001;32 (6) 446- 455
PubMed
Gogate  PMDeshpande  MWormald  RP Is manual small incision cataract surgery affordable in the developing countries? A cost comparison with extracapsular cataract extraction. Br J Ophthalmol 2003;87 (7) 843- 846
PubMed
Gogate  PDeshpande  MNirmalan  PK Why do phacoemulsification? Manual small-incision cataract surgery is almost as effective, but less expensive. Ophthalmology 2007;114 (5) 965- 968
PubMed
Saw  SMTseng  PChan  WKChan  TKOng  SGTan  D Visual function and outcomes after cataract surgery in a Singapore population. J Cataract Refract Surg 2002;28 (3) 445- 453
PubMed
Brown  MMBrown  GCSharma  SSmith  AFLandy  J A utility analysis correlation with visual acuity: methodologies and vision in the better and poorer eyes. Int Ophthalmol 2001;24 (3) 123- 127
PubMed
Sarikkola  AUKontkanen  MKivela  TLaatikainen  L Simultaneous bilateral cataract surgery: a retrospective survey. J Cataract Refract Surg 2004;30 (6) 1335- 1341
PubMed
Johansson  BALundh  BL Bilateral same day phacoemulsification: 220 cases retrospectively reviewed. Br J Ophthalmol 2003;87 (3) 285- 290
PubMed
Castells  XAlonso  JCastilla  MRibó  CCots  FAntó  JM Outcomes and costs of outpatient and inpatient cataract surgery: a randomised clinical trial. J Clin Epidemiol 2001;54 (1) 23- 29
PubMed
Lundström  MAlbrecht  SNilsson  MÅström  B Benefit to patients of bilateral same-day cataract extraction: randomized clinical study. J Cataract Refract Surg 2006;32 (5) 826- 830
PubMed
Fan  YPBoldy  DBowen  D Comparing patient satisfaction, outcomes and costs between cataract day surgery and inpatient surgery for elderly people. Aust Health Rev 1997;20 (4) 27- 39
PubMed
Saad Filho  RSaad  FGFreitas  LL Cost of phacoemulsification in the national campaign of elective cataract surgery in Itapolis, SP, Brazil [article in Portuguese]. Arq Bras Oftalmol 2005;68 (1) 55- 59
PubMed
Chen  SArshinoff  S A cost-analysis of unilateral vs. simultaneous bilateral surgery in Canada. Clin Surg Ophthalmol 2005;23324- 332
Lin  Y Comparative study on preventing avoidable blindness in China and in Nepal. Chin Med J (Engl) 2007;120 (4) 280- 283
PubMed
Anderson  GBlack  CDunn  E  et al.  Willingness to pay to shorten waiting time for cataract surgery. Health Aff (Millwood) 1997;16 (5) 181- 190
PubMed
Melese  MAlemayehu  WFriedlander  ECourtright  P Indirect costs associated with accessing eye care services as a barrier to service use in Ethiopia. Trop Med Int Health 2004;9 (3) 426- 431
PubMed
Orme  MEPaine  ACTeale  CWKennedy  LM Cost-effectiveness of the AMOArray multifocal intraocular lens in cataract surgery. J Refract Surg 2002;18 (2) 162- 168
PubMed
Landwehr  ITehrani  MDick  HBKrummenauer  F Cost effectiveness evaluation of cataract patient care in respect of monofocal intraocular lenses from the perspective of German statutory health insurance [article in German]. Klin Monatsbl Augenheilkd 2003;220 (8) 532- 539
PubMed
Pagel  NDick  HBKrummenauer  F Incremental cost effectiveness of multifocal cataract surgery [article in German]. Klin Monatsbl Augenheilkd 2007;224 (2) 101- 109
PubMed
Shmueli  AIntrator  OIsraeli  A The effects of introducing prospective payments to general hospitals on length of stay, quality of care, and hospitals' income: the early experience of Israel. Soc Sci Med 2002;55 (6) 981- 989
PubMed
Lewallen  SEliah  EGilbert  S The cost of outreach services in eastern Africa. IAPB News. 2006; ((50)) 16- 17http://www.iapb.org/newsletters/50_august-newsletter-2006.pdf. Accessed November 2, 2007
Marseille  E Cost-effectiveness of cataract surgery in a public health eye care programme in Nepal. Bull World Health Organ 1996;74 (3) 319- 324
PubMed
Marseille  EGilbert  S The cost of cataract surgery in a public health eye care program in Nepal. Health Policy 1996;35 (2) 145- 154
PubMed
Ruit  STabin  GCNissman  SAPaudyal  GGurung  R Low-cost high-volume extracapsular cataract extraction with posterior chamber intraocular lens implantation in Nepal. Ophthalmology 1999;106 (10) 1887- 1892
PubMed
King  A $17 million for extra cataract operations. http://www.beehive.govt.nz/?q=node/22876. Published May 3, 2005. Accessed November 12, 2007
Osahon  AI Cataract surgery output and cost of hospitalization for cataract surgery in the University of Benin Teaching Hospital. West Afr J Med 2002;21 (3) 174- 176
PubMed
Lundström  MBrege  KGFloren  IRoos  PStenevi  UThorburn  W Cataract surgery and effectiveness, 1: variation in costs between different providers of cataract surgery. Acta Ophthalmol Scand 2000;78 (3) 335- 339
PubMed
Minassian  DCRosen  PDart  JK  et al.  Extracapsular cataract extraction compared with small incision surgery by phacoemulsification: a randomised trial. Br J Ophthalmol 2001;85 (7) 822- 829
PubMed
Afsar  AJWoods  RLPate  SRogan  FWykes  W Economic costs of cataract surgery using a rigid and a foldable intraocular lens. Ophthalmic Physiol Opt 2001;21 (4) 262- 267
PubMed
Naeim  AKeeler  EBGutierrez  PRWilson  MRReuben  DMangione  CM Is cataract surgery cost-effective among older patients with a low predicted probability for improvement in reported visual functioning? Med Care 2006;44 (11) 982- 989
PubMed
Rein  DBZhang  PWirth  KE  et al.  The economic burden of major adult visual disorders in the United States. Arch Ophthalmol 2006;124 (12) 1754- 1760
PubMed
Pager  CK McCluskey  PJRetsas  C Cataract surgery in Australia: a profile of patient-centered outcomes. Clin Experiment Ophthalmol 2004;32 (4) 388- 392
PubMed
Kirkwood  BJPesudovs  KLatimer  PCoster  DJ The efficacy of a nurse-led preoperative cataract assessment and postoperative care clinic. Med J Aust 2006;184 (6) 278- 281
PubMed
Nascimento  MALira  RPSoares  PHSpessatto  NKara-José  NArieta  CE Are routine preoperative medical tests needed with cataract surgery? Study of visual acuity outcome. Curr Eye Res 2004;28 (4) 285- 290
PubMed
Norregaard  JCHindsberger  CAlonso  J  et al.  Visual outcomes of cataract surgery in the United States, Canada, Denmark, and Spain: report from the International Cataract Surgery Outcomes Study. Arch Ophthalmol 1998;116 (8) 1095- 1100
PubMed
Norregaard  JCBernth-Petersen  PAlonso  JAndersen  TFAnderson  GF Visual functional outcomes of cataract surgery in the United States, Canada, Denmark, and Spain: report of the International Cataract Surgery Outcomes Study. J Cataract Refract Surg 2003;29 (11) 2135- 2142
PubMed
Noertjojo  KMildon  DRollins  D  et al.  Cataract surgical outcome at the Vancouver Eye Care Centre: can it be predicted using current data? Can J Ophthalmol 2004;39 (1) 38- 47
PubMed
He  MXu  JLi  SWu  KMunoz  SREllwein  LB Visual acuity and quality of life in patients with cataract in Doumen County, China. Ophthalmology 1999;106 (8) 1609- 1615
PubMed
Bassett  KLNoertjojo  KLiu  L  et al.  Cataract surgical coverage and outcome in the Tibet Autonomous Region of China. Br J Ophthalmol 2005;89 (1) 5- 9
PubMed
Zerihun  N Visual outcome of the first 500 cataract extractions done in the field; Jimma, Ethiopia. Int Ophthalmol 2001;24 (5) 291- 295
PubMed
Kohnen  SFerrer  ABrauweiler  P Visual function in pseudophakic eyes with poly(methyl methacrylate), silicone, and acrylic intraocular lenses. J Cataract Refract Surg 1996;22 ((suppl 2)) 1303- 1307
PubMed
Dandona  LDandona  RAnand  RSrinivas  MRajashekar  V Outcome and number of cataract surgeries in India: policy issues for blindness control. Clin Experiment Ophthalmol 2003;31 (1) 23- 31
PubMed
Gogate  PMDeshpande  MWormald  RPDeshpande  RKulkarni  SR Extracapsular cataract surgery compared with manual small incision cataract surgery in community eye care setting in western India: a randomised controlled trial. Br J Ophthalmol 2003;87 (6) 667- 672
PubMed
Mamidipudi  PRVasavada  ARMerchant  SVNamboodiri  VRavilla  TD Quality-of-life and visual function assessment after phacoemulsification in an urban Indian population. J Cataract Refract Surg 2003;29 (6) 1143- 1151
PubMed
Venkatesh  RMuralikrishnan  RBalent  LCPrakash  SKPrajna  NV Outcomes of high volume cataract surgeries in a developing country. Br J Ophthalmol 2005;89 (9) 1079- 1083
PubMed
Leshno  MReuveni  H Inappropriateness of cataract extraction: an analysis in two Israeli hospital settings. Clin Perform Qual Health Care 1999;7 (1) 23- 27
PubMed
Yorston  DGichuhi  SWood  MFoster  A Does prospective monitoring improve cataract surgery outcomes in Africa? Br J Ophthalmol 2002;86 (5) 543- 547
PubMed
Hennig  AKumar  JYorston  DFoster  A Sutureless cataract surgery with nucleus extraction: outcome of a prospective study in Nepal. Br J Ophthalmol 2003;87 (3) 266- 270
PubMed
Ruit  STabin  GChang  D  et al.  A prospective randomized clinical trial of phacoemulsification vs manual sutureless small-incision extracapsular cataract surgery in Nepal. Am J Ophthalmol 2007;143 (1) 32- 38
PubMed
Riley  AFMalik  TYGrupcheva  CNFisk  MJCraig  JP McGhee  CN The Auckland cataract study: co-morbidity, surgical techniques, and clinical outcomes in a public hospital service. Br J Ophthalmol 2002;86 (2) 185- 190
PubMed
Alhassan  MBKyari  FAchi  IBOzemela  CPAbiose  A Audit of outcome of an extracapsular cataract extraction and posterior chamber intraocular lens training course. Br J Ophthalmol 2000;84 (8) 848- 851
PubMed
Wang  JCTan  AWMonatosh  RChew  PT Experience with ARRAY multifocal lenses in a Singapore population. Singapore Med J 2005;46 (11) 616- 620
PubMed
Waddell  KMReeves  BCJohnson  GJ A comparison of anterior and posterior chamber lenses after cataract extraction in rural Africa: a within patient randomised trial. Br J Ophthalmol 2004;88 (6) 734- 739
PubMed
Desai  PMinassian  DCReidy  A National cataract surgery survey 1997-8: a report of the results of the clinical outcomes. Br J Ophthalmol 1999;83 (12) 1336- 1340
PubMed
Tinley  CGFrost  AHakin  KN McDermott  WEwings  P Is visual outcome compromised when next day review is omitted after phacoemulsification surgery? A randomised control trial. Br J Ophthalmol 2003;87 (11) 1350- 1355
PubMed
Zaidi  FHCorbett  MCBurton  BJBloom  PA Raising the benchmark for the 21st century—the 1000 cataract operations audit and survey: outcomes, consultant-supervised training and sourcing NHS choice. Br J Ophthalmol 2007;91 (6) 731- 736
PubMed
Lum  FSchein  OSchachat  APAbbott  RLHoskins  HD  JrSteinberg  EP Initial two years of experience with the AAO National Eyecare Outcomes Network (NEON) cataract surgery database. Ophthalmology 2000;107 (4) 691- 697
PubMed
Tobacman  JKZimmerman  BLee  PHilborne  LKolder  HBrook  RH Visual acuity following cataract surgeries in relation to preoperative appropriateness ratings. Med Decis Making 2003;23 (2) 122- 130
PubMed
Killestein  JHillegers  Mvan der Windt  CStilma  JS Outcome of cataract surgery by a general medical doctor at district level, Zimbabwe: a retrospective follow-up study. Int Ophthalmol 1996-1997;20 (5) 279- 283
PubMed
Brouwer  WBNiessen  LWPostma  MJRutten  FF Need for differential discounting of costs and health effects in cost effectiveness analyses. BMJ 2005;331 (7514) 446- 448
PubMed
Claxton  KSculpher  MCulyer  A  et al.  Discounting and cost-effectiveness in NICE—stepping back to sort out a confusion. Health Econ 2006;15 (1) 1- 4
PubMed
Bos  JMPostma  MJAnnemans  L Discounting health effects in pharmacoeconomic evaluations: current controversies. Pharmacoeconomics 2005;23 (7) 639- 649
PubMed
Badia  XMonserrat  SRoset  MHerdman  M Feasibility, validity and test-retest reliability of scaling methods for health states: the visual analogue scale and the time trade-off. Qual Life Res 1999;8 (4) 303- 310
PubMed
Pesudovs  KGaramendi  EKeeves  JPElliott  DB The Activities of Daily Vision Scale for cataract surgery outcomes: re-evaluating validity with Rasch analysis. Invest Ophthalmol Vis Sci 2003;44 (7) 2892- 2899
PubMed
Lundström  MWendel  E Duration of self assessed benefit of cataract extraction: a long term study. Br J Ophthalmol 2005;89 (8) 1017- 1020
PubMed
Sach  THFoss  AJGregson  RM  et al.  Falls and health status in elderly women following first eye cataract surgery: an economic evaluation conducted alongside a randomised controlled trial. Br J Ophthalmol 2007;91 (12) 1675- 1679
PubMed
World Health Organization, Cost effectiveness thresholds. http://www.who.int/choice/costs/CER_thresholds/en/index.html. Accessed May 20, 2008

Correspondence

CME


You need to register in order to view this quiz.
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).
Submit a Comment

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Topics
PubMed Articles