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Immediate versus delayed sequential bilateral cataract surgery in children: a cost-effectiveness analysis.

Alexandra Cernat1,2, Margaret Jamieson1, RuthAnne Kavelaars1

  • 1Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada.

The British Journal of Ophthalmology
|November 21, 2020
PubMed
Summary

Immediate sequential bilateral cataract surgery (ISBCS) is more cost-effective than delayed surgery (DSBCS) for children. ISBCS offers significant cost savings without compromising visual outcomes.

Keywords:
child health (paediatrics)treatment surgery

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Area of Science:

  • Ophthalmology
  • Health Economics
  • Pediatric Surgery

Background:

  • Children with bilateral cataracts face surgical choices: immediate sequential bilateral cataract surgery (ISBCS) or delayed sequential bilateral cataract surgery (DSBCS).
  • ISBCS, performed under a single anesthesia, carries a risk of bilateral endophthalmitis, leading to cautious adoption.
  • ISBCS offers benefits like avoiding multiple anesthesias and faster visual recovery, but its cost-effectiveness in children remains understudied.

Purpose of the Study:

  • To conduct a cost-effectiveness analysis comparing ISBCS and DSBCS in children.
  • To evaluate ISBCS versus DSBCS from both societal and health system perspectives in Ontario, Canada.

Main Methods:

  • A retrospective analysis of 53 children undergoing ISBCS or DSBCS at a pediatric referral hospital.
  • A decision tree model was used with a clear visual axis as the effectiveness measure and an 8-week postoperative time horizon.
  • Included direct and indirect costs for a comprehensive economic evaluation.

Main Results:

  • ISBCS and DSBCS demonstrated equal effectiveness in achieving a clear visual axis.
  • ISBCS resulted in cost savings of $3,776 CAD per patient from the societal perspective.
  • ISBCS yielded cost savings of $2,200 CAD per patient from the health system perspective.

Conclusions:

  • Immediate sequential bilateral cataract surgery (ISBCS) is less costly than delayed surgery (DSBCS).
  • ISBCS is equally effective as DSBCS in pediatric cataract patients.
  • ISBCS presents a more cost-effective approach for managing bilateral pediatric cataracts.