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Analysis finds procedure extremely cost effective; ROI has net $123.4 billion over 13 years
By Lynda Charters; Reviewed by Melissa M. Brown, MD, MN, MBA
Philadelphia-A cost-utility analysis of cataract surgery found that patients, society, Medicaid, and Medicare benefit greatly from the procedure, specifically $123.4 billion over 13 years.
Value-Based Medicine is the practice of medicine based on the patient value and the financial value gained from medical interventions.
“Our value is only as good as the evidence-based clinical studies,” said Melissa M. Brown, MD, MN, MBA, professor of ophthalmology, Thomas Jefferson University, senior research associate, Wills Eye Institute, and president and chief executive officer, Center for Value-Based Medicine, Philadelphia. “We start with good clinical trials, attach the appropriate patient value, and then evaluate the costs to determine the financial value.”
Improvements in the length or quality of life (QOL) are the values to patients; in ophthalmology, that improvement is enhanced QOL through increased visual acuity.
Dr. Brown and colleagues used the results of the Patient Outcomes Research Team (PORT) Study (Norregaard JC et al. Arch Ophthalmol. 1998;116:1095-1100) as the basis for their cost-utility analysis. In the Port Study following cataract surgery, patients’ vision improved from the mean preoperative value of 20/83 to a mean of 20/27 postoperatively.
She reported that in the 13-year model in the PORT Study, the mean age through the end of life, cataract surgery conveyed a gain of 1.62 QOL years (QALYs) or a 20.8% gain in patient value.
“This gain is in the first eye,” she said. When the second eye undergoes cataract surgery, the QOL value increases to 2.8 QALYs over 13 years, which is a 36.2% improvement in QOL.
“This represents a huge increase in the value to a patient,” she said.
The financial value of cataract surgery was also found to be tremendous. In addition to the third-party costs, Dr. Brown also discussed the societal perspective that includes indirect medical costs (employment) and direct nonmedical costs (caregiver costs).
“The direct medical cost for unilateral cataract surgery in 2012 was $2,653,” she said. “This was 34% lower than in 2000 and 85% less than in 1985. The physician fee in 2012 was 10% of that in 1985.”
An important finding related to societal costs is that the third-party insurers gain from the lower levels of depression, fewer injuries, less need for nursing home and caregiver care, and increased wages as a result of improved vision after cataract surgery.
“The societal return on investment (ROI) for the first-eye surgery over 13 years for one patient was $121,198-a gain of 4,567%,” she said.
The cataract surgery ROI was a net $123.4 billion over 13 years, specifically, Medicare, $36.4 billion; Medicaid, $3.3 billion; third-party insurers, $9.6 billion; patients, $48.6 billion; and U.S. productivity, $25.4 billion.
“A cost-utility analysis of cataract surgery in 2012 found that it is extremely cost effective,” Dr. Brown added. “The surgery conferred great patient value, excellent cost-effectiveness, considerable financial value, and a substantial financial ROI to Medicare, Medicaid, patients, and society referent to the direct, medical costs expended.” ï®
Melissa M. Brown, MD, MN, MBA
Dr. Brown has no financial interest in the subject matter.
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