An economic evaluation of phacoemulsification and extracapsular cataract extraction in cataract surgery

Abstract

Background/Aim. Cataract surgery is one of the most often performed surgical interventions. The predominant method in Western countries is phacoemulsification, while in developing countries, the extracapsular cataract extraction (ECCE) method remains popular. The aim of the study was to evaluate the cost- effectiveness of these two cataract surgery techniques from the provider’s perspective if operation complications were the out- come of the interest. Methods. The data were obtained from the Department of Ophthalmology of the General Hospital Kruševac during a one-year period. A total of 1,179 surgeries by five surgeons were performed. The cost-effectiveness was evaluated using the decision tree. All probabilities were calcu- lated based on the likelihood of the occurrence during the study period. Only direct costs were considered, and values were taken from the documentation at the hospital and the of- ficial price list of health services. One- and two-way sensitivity analyses were performed. Results. The total cost per patient in the phacoemulsification group was 71,008.70 Serbian dinars (RSD), while the total cost in the ECCE group was 74,340.36 RSD. At the same time, phacoemulsification shows higher ef- fectiveness than the ECCE method, with 87% and 57% of pa- tients without complications, respectively. With these results, phacoemulsification was the dominant strategy compared to ECCE. The sensitivity analysis revealed that the results are sen- sitive to the number of performed operations per year. Con- clusion. The phacoemulsification technique seems to be the preferred technique for cataract surgery. All the investment in phacoemulsification equipment and consumables is justified if the number of surgeries per year exceeds 350.

Uvod/Cilj. Operacija katarakte predstavlja jednu od najčešće primenjivanih hirurških intervencija. U zapadnim zemljama, dominantna tehnika je fakoemulzifikacija, dok je u zemljama u razvoju najzastupljenija tehnika ekstrakapsularne ekstrakcije (ECCE). Cilj rada bio je da se proceni ekonomska isplativost te dve tehnike operacije katarakte iz perspektive pružaoca usluge, ukoliko se kao ishod posmatraju komplikacije. Metode. Podaci su dobijeni sa Očnog odeljenja Opšte bolnice Kruševac tokom jednogodišnjeg perioda. Ukupno je izvedeno 1 179 operacija od strane pet hirurga. Ekonomska isplativost je procenjena primenom „drveta odlučivanja“. Verovatnoće za događaje su izračunate na osnovu verovatnoće pojavljivanja tokom navedenog perioda. U analizi su razmatrani samo direktni troškovi, a vrednosti su preuzete iz prateće dokumentacije i zvaničnog cenovnika zdravstvenih usluga. Sprovedena je jednosmerna i dvosmerna analiza osetljivosti. Rezultati.Ukupni troškovi u grupi koja je bila podvrgnuta fakoemulzifikaciji iznosili su 71 008.70 srpskih dinara (RSD), dok su u ECC E grupi oni iznosili 74 340.36 RSD. Istovremeno, fakoemulzifikacija je pokazala višu efikasnost u odnosu na ECCE, 87% i 57% bolesnika bez komplikacija, redom. Na osnovu dobijenih rezultata, fakoemulzifikacija je bila dominantna strategija u poređenju sa ECCE. Analiza osetljivosti pokazala je da su rezultati osetljivi na broj izvršenih intervencija na godišnjem nivou. Zaključak. Fakoemulzifikacija je ekonomski isplativija tehnika operacije katarakte u odnosu na ECCE. Sva ulaganje u opremu i potrošni materijal za fakoemulzifikaciju opravdani su ukoliko je broj izvedenih operacija na godišnjem nivou preko 350.