Cost-Utility Analysis of Immediate Sequential and Delayed Sequential Bilateral Cataract Surgery in a Middle-Income...

To evaluate the cost-utility of immediate sequential versus delayed sequential bilateral cataract surgery (ISBCS vs DSBCS) in a real-world setting at a Thai government hospital.

In this prospective cohort study, eligible patients undergoing ISBCS or DSBCS followed a standardized surgical and postoperative protocol. In ISBCS, the second eye was treated as a new case with full instrument replacement. DSBCS followed the same procedure with a surgeon-determined interval between surgeries. Cost-utility analysis was conducted from a societal perspective, with cost-effectiveness defined as an incremental cost-effectiveness ratio (ICER) below Thailand's willingness-to-pay threshold (160,000 THB per quality-adjusted life-year [~US$4600]). Sensitivity analyses (one-way and bootstrapping) tested the robustness of the results.

Among 99 enrolled patients (45 ISBCS, 54 DSBCS), 89 were included in the analysis (44 ISBCS, 45 DSBCS) after excluding eight DSBCS patients and one ISBCS patient based on the study's exclusion criteria. Compared to DSBCS, the ISBCS group was younger but similar in other baseline characteristics. No intraoperative complications occurred, and postoperative complication rates were comparable between groups. The cost-utility analysis, using a 3-month time horizon, identified ISBCS as the dominant strategy, with a cost saving of 3335 THB (~US$100) per patient and a slightly higher effectiveness. These findings were confirmed by sensitivity analyses.

ISBCS offers substantial cost savings, comparable safety, and a slight quality-of-life advantage over DSBCS, making it a cost-effective option for bilateral cataract surgery in Thailand.