One line of regained visual acuity is a snip at just €120

By Stefanie Petrou-Binder MD

NUERNBERG - The €120 cost to the insurer of one line of regained visual acuity is good value considering the significant associated improvements in patients'quality of life, according to an investigation carried out at Mainz University, Germany.
Why figure out what one line of regained visual acuity costs? At this year's Congress of German Ophthalmic Surgeons, Frank Krummenauer MD, DSc and colleagues explained that for an accurate cost evaluation of cataract surgery, the patient's subjective and objective visual acuity improvements must be seen relative to the direct expenses carried by the insurer.

The researchers determined that each gained line of visual acuity resulting from cataract surgery effectively costs the health insurer E120.
With visual acuity improvements that have been attained at up to five lines per operated eye, the obvious cost effectiveness of cataract surgery is a relevant aspect to consider in light of patient satisfaction associated with regained vision.
In addition, it represents a straight argument in reimbursement discussions with insurers.
The investigation was carried out by the Mainz University's Co-ordination Centre for Clinical Trials (KKS) and its goal was to evaluate cataract surgery from an economic viewpoint.

As most studies consider only the number of visual acuity lines gained following cataract surgery - the functional measurable improvement - the authors considered it valid as a surrogate endpoint for patient satisfaction and objective clinical outcome in an assessment of cost effectiveness.
However, they pointed out that additional cost effectiveness correction for quality of life data was performed.

Since the gain in visual acuity substantially correlates with the major determinants of quality of life and cataract patients' satisfaction, this correction did not significantly change the overall findings.
The team used the visual acuity improvement obtained in patients operated on as an input parameter to quantify the expense entailed per line of gained acuity.
As each gained line represents an incremental rise in patient satisfaction and in the quality of life of the patient, the authors sought to estimate the value of the "individual visual acuity line".

To obtain the necessary data, the authors carried out a meta-analysis on the efficacy of cataract surgery based on monofocal IOL implantation beginning in 1991 and including clinical trials until 2001.
They studied online ophthalmic surgical sources, principally Medline and PubMed, using key words such as "cataract and quality of life", "cataract and benefit", "cataract and effectiveness", and "cataract and patient satisfaction" to amass input data.

Meta-analysis
Included in this meta-analysis were prospective randomised trials involving at least 40 patients per therapy arm.

The net expense carried by the insurance companies was estimated to be approximately €600 per patient operated on in hospital within the chosen 10-year time frame, including patient-associated care expenses and material costs.
The overall cost estimates were provided by Burkhard Dick MD, Department of Refractive Surgery, University of Mainz Eye Hospital, Mainz, Germany.
Annette Lohmeier MD included 25 clinical trials in their meta-analysis which fulfilled their confirmatory set of criteria. The poster displayed three criteria typical of these studies.

One example study showed a median increase in visual acuity from 20/100 to 20/33 within two months after surgery with 99% of these patients reporting satisfaction with the treatment and 88% with their visual results.
A second one showed visual acuity improvements of less than or equal to 20/30 in 80% of patients one month following surgery.

Finally, one of the studies introduced to the meta-analysis showed a visual acuity improvement from less than 20/200 to greater than or equal to 20/60 in 15% of patients without correction and in 38% of the same patient group with correction.

The overall meta-analysis revealed a median visual acuity improvement of five lines; as cataract surgery/care roughly costs the insurer E600 during the time range of the analysis, the value of one gained line is approximately E120.

Dr Krummenauer and Dr Lohmeier emphasised that, although their meta-analysis could not be comprehensive because of publication bias and the quite specific inclusion criteria involving both effectiveness and outcome quality, the estimated cost per visual acuity line at least offers an interesting viewpoint for further discussion and prospective analysis.

They added that further studies must focus on patient satisfaction and improved quality of life as a vital aspect of cataract surgery, in addition to the objective clinical goal of improving visual acuity.

"However, the cost effectiveness of cataract surgery can, at least in a first surrogate analysis step, be estimated by evaluating the incremental improvement of visual acuity per gained line in comparison to the expenses the insurer carries corrected for the self-reported gain in patient satisfaction and quality of life. The latter can be assessed by means of psychometric analysis," Dr Krummenauer said.

Top