Cost-effectiveness analysis of manual small incision cataract surgery (MSICS) and phacoemulsification (PE)

摘要

Background: Cataract is the most common cause of blindness, responsible for 50 to 80% of all blindness in South-East Asia. Method of cataract surgery that has cost-effective, low technology procedure and a low complication rate in the shortest amount of time is needed. This study provides the useful resources comparing clinical outcomes and cost of phacoemulsification (PE) and manual small incision cataract surgery (MSICS) based on hospital perspective. Objective: To compare the costs and effectiveness of two-cataract-surgery methods, MSICS and PE, using the hospital's perspective. Setting: Department of Ophthalmology, Phrapoklao hospital, Thailand. Material and Method: This study was prospective and comparative. Data was collected from medical charts and through patient interviews using data collection forms. Labor, material and capital cost were recorded for both surgical methods. The effectiveness was measured in visual acuity (VA), astigmatism and complications occurring at 90 days after surgery. Results: The average total cost was 10,043.81bath/case for MSICS and 11,590.72bath/case for PE. After 90 days after surgery, the average VA of MSICS and PE groups were 0.83 ± 0.225 (0.10-1.00) and 0.76 ± 0.268 (0.06-1.00). There was no statistically significant difference in both groups. The average astigmatism at 90 days after surgery was 1.01 ± 0.733 (0.00-3.50) D and 0.99 ± 0.713 (0.00-4.25) D for MSICS and PE method. The average change in astigmatism was 0.15 and 0.20 D for the MSICS and PE groups. The intraoperative complication was vitreous loss (1.40%) in the PE group. The postoperative complication was corneal edema (5.60%) in the MSICS group. There was no statistically significant difference in the number of postoperative complications in both groups (p = 0.16). Conclusion: The effectiveness of MSICS and PE methods was not significantly different, but PE method had higher costs. Therefore, MSICS has better cost-effectiveness than PE thus, MSICS should be a preferred cataract surgery method to PE method, based on the hospital's perspective.