Is Cataract Surgery Cost-Effective Among Older Patients with a Low Predicted Probability for Improvement in Reported Visual Functioning

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 $38,288/QALY. In the subgroup of patients with a CSI score >11 (<20% probability of improvement), the cost-effectiveness of cataract surgery was $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.