Immediate versus delayed sequential bilateral cataract surgery: an analysis of costs and patient value

Abstract

To compare resource utilization of two different strategies for bilateral cataract surgery: immediate sequential cataract surgery (ISCS) versus delayed sequential cataract surgery (DSCS). The purpose was also to analyse the value for the patient of undergoing ISCS versus DSCS. Differences in routines and resource utilization between ISCS (n = 17) and DSCS (n = 80) were studied in a cohort of cataract surgery patients at our clinic in Karlskrona, Sweden. Costs were extracted from an earlier publication by the same clinic. The value for the patient was studied using the capability index, based on published data on the benefit to the patient of ISCS or DSCS using the Catquest questionnaire. Operating both eyes of a patient was 1.14 times more expensive with DSCS than with ISCS including all surgical costs. The value to the patient of undergoing ISCS depended on the time between first- and second-eye surgery in DSCS and the remaining lifetime after both-eye surgery. A long waiting time for second-eye surgery and a short remaining lifetime decreased the patient value of DSCS compared to ISCS. DSCS is 14% more expensive than ISCS. The value for the patient of ISCS compared to DSCS depends on how long the period will be between first- and second-eye surgery in DSCS and also on the patient's survival time after surgery.