Economic Evaluation of Alternative Programs of Reduced-Stay Senile Cataract Surgery

Senile cataracts are a leading cause of sight loss and accompanying disability among the elderly. The demand for cataract surgery to restore vision is likely to increase in the future due to the aging of the Canadian population, increasing patient expectations, and technological improvements. Reducing the length of traditional hospital post-operative care following surgery has been suggested as an approach for improving treatment efficiency. The paper examines evidence of clinical effectiveness and determines the costs of alternative modes of post-operative care from the perspectives of the health-care system, patients and informal care-givers, and society. Costs and consequences are compared using cost-minimization analysis methodology. Although reduced-stay surgery appears to offer opportunities for potential resource savings, distributional consequences of substituting community for traditional hospital post-operative recovery may inhibit its widescale acceptance. Transfers of funding from hospitals to home-care agencies and informal care-givers may therefore be required to redress these distributional consequences. Given that outpatient surgery appears to be no less clinically effective than inpatient and overnight alternatives, policy-makers should consider strategies to take advantage of these potential resource savings.