Clinical performance analysis and cost-utility analysis of a mobile cataract surgery service in a rural setting in Thailand

Mantapond Ittarat , Wanrudee Isaranuwatchai , Sunee Chansangpetch
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Abstract

Purpose

To evaluate a clinical performance and cost-effectiveness of a mobile cataract surgery service, specifically and separately for Phacoemulsification (Phaco) and extracapsular cataract extraction (ECCE)

Design

A pre-post study with individual-level data

Methods

Patients diagnosed with advanced cataracts underwent cataract surgery at a mobile cataract surgery service. Data on corrected distance visual acuity (CDVA), quality of life (QOL) assessed by EQ-5D-5L questionnaire, and cost were prospectively collected at and compared between baseline and 3 months after treatment. Linear regression was used to analyze the clinical performance, and a cost-utility analysis (CUA) was conducted to show the cost-effectiveness of the mobile service.

Results

A total of 98 eyes from 98 patients had cataract surgeries, with 53 patients (54 %) undergoing Phaco techniques and 45 patients (46 %) undergoing ECCE techniques. For the total cohort, LogMAR CDVA changed from 1.88±0.59 to 0.23±0.23 (p < 0.001) with only one case of complication. Significant improvements of mobility and usual activities QOL scores, and utility values were demonstrated (all p < 0.001). Separate CUAs by technique with pre-post data showed that patients with Phaco gained 4.93 QALYs and costed approximately THB 18,800 (USD 535) and patients with ECCE gained 5.45 QALYs with the cost of THB 14,400 (USD 412).

Conclusions

A mobile cataract surgery service is effective in improving vision and QOL with a low complication rate. The CUAs showed that both Phaco and ECCE could be cost-effective. Implementing such services in rural areas could be a strategy to increase effective cataract surgery coverage.
泰国农村地区流动白内障手术服务的临床表现分析和成本效用分析
目的评估移动白内障手术服务的临床表现和成本效益,特别是分别用于超声乳化(Phaco)和白内障囊外摘出(ECCE)设计的一项个人水平数据的前后研究。采用EQ-5D-5L问卷评估两组患者的矫正距离视力(CDVA)、生活质量(QOL)和治疗后3个月的成本数据,并进行前瞻性收集和比较。使用线性回归分析临床表现,并进行成本效用分析(CUA)来显示移动服务的成本效益。结果98例患者共98眼行白内障手术,其中53例(54%)行Phaco技术,45例(46%)行ECCE技术。对于整个队列,LogMAR CDVA从1.88±0.59变为0.23±0.23 (p <;0.001),只有一例并发症。移动性和日常活动质量评分显著改善,效用值也得到了证明(所有p <;0.001)。通过技术和前后数据进行的单独CUAs显示,Phaco患者获得4.93个QALYs,费用约为18,800泰铢(535美元),ECCE患者获得5.45个QALYs,费用为14,400泰铢(412美元)。结论移动白内障手术可有效改善患者视力和生活质量,并发症发生率低。评价结果表明,Phaco和ECCE都具有成本效益。在农村地区实施这种服务可能是增加白内障手术有效覆盖率的一种策略。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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