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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.
Insights
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.
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.
Background/Aims:
Children with bilateral cataracts may undergo immediate sequential bilateral cataract surgery (ISBCS), which involves surgery on both eyes during the same general anaesthesia, or delayed sequential bilateral cataract surgery (DSBCS), which involves operating on each eye on separate days and requires a second anaesthesia. ISBCS is viewed with caution because of the risk of bilateral endophthalmitis. Proponents of ISBCS emphasise that the incidence of serious complications is low and is outweighed by benefits such as avoidance of multiple anaesthesia, faster visual rehabilitation and potential for decreased costs. However, there is a paucity of literature regarding the cost-effectiveness of ISBCS in children. We conducted a cost-effectiveness analysis to determine whether ISBCS is more cost-effective than DSBCS from the societal and health system perspectives in Ontario, Canada, which has a universal, single-payer system.
Methods:
A retrospective analysis of children who underwent ISBCS or DSBCS at a tertiary referral paediatric hospital was conducted. A decision tree was constructed using TreeAge Pro 2018 software. Clear visual axis was the measure of effectiveness. A time horizon of 8 weeks postoperatively was adopted. Both direct and indirect costs were included.
Results:
Fifty-three children were included, 37 in the ISBCS group and 16 in the DSBCS group. ISBCS and DSBCS were equally effective. ISBCS resulted in cost-savings of $3,776 (95% CI:-$4,641 to $12,578) CAD, per patient, from the societal perspective and $2,200 (95% CI:-$5,615 to $10,373) CAD per patient from the health system perspective.
Conclusion:
ISBCS was less costly than DSBCS from both societal and health system perspectives while being equally effective.
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