Evidence Based Cost-effectiveness Analysis for Cataract Surgery
Landwehr I.1, Dick H. B.2, Krummenauer F.1
1Department of Medical Biometry, Epidemiology and Informatics, 2University Eye Hospital, Medical School, University of Mainz
Purpose: Increasing budget limitations in health care systems strongly call for rationales for the distribution of ressources. To evaluate cataract surgery from a health economical perspective, a meta analysis of its cost effectiveness was performed.
Method: Primary endpoint of the analysis were the incremental costs per gained visual acuity unit from the German health service's perspective. A meta analysis of German and English journal articles (published between 1995 and 2002) was performed to derive a median estimate of the increase in visual acuity after cataract surgery; this surrogate parameter for its clinical effectiveness was then related to the recent reimbursement rate (Fallpauschale) in Germany. Additionally, a meta analysis on reported PCO rates provided a median capsulotomy rate estimate for the correction of the overall incremental costs with regard to cost increase due to PCO. Inclusion criteria for both meta analyses were the standard Cochrane Collaboration's requirements on systematic reviews; references were scanned using MedLine.
Results: A total of 51 trials could be introduced into the visual acuity meta analysis, a total of 83 studies into the PCO meta analysis. Despite the effect of cofactors like lens material, (edge) design and study design, an
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