The Cost-Effectiveness, Cost-Utility, and Ecological Impact of a New Immediate Sequential Bilateral Cataract Surgery Method

Purpose : To determine the cost-effectiveness, cost-utility, and ecological impact of a new immediate sequential bilateral cataract surgery (ISBCS) method, in which both eyes are operated on in one procedure using the same protective clothing and coverings. Setting : A retrospective comparison was conducted in western Finland, involving operations performed in one public hospital and two private hospitals, as well as a university hospital. Design : Retrospective cohort study. Methods : Data from 6698 patients (11453 eyes) were examined. Three cohorts were analysed. The new ISBCS method cohort (2328 patients/4656 eyes) performed by one senior surgeon in both public and private hospitals, a traditional ISBCS control group (2427 patients/4854 eyes) in a university hospital, and a unilateral cataract control group (1943 patients/1943 eyes) by the same senior surgeon in a public hospital. Main outcomes measured included material costs, personnel costs, quality-adjusted life-year (QALY) costs, and carbon footprint. Results : Compared with traditional ISBCS and unilateral control groups, the new ISBCS method resulted in a 24.6% reduction in total costs per eye and a 28.6% reduction in personnel costs per eye. The new ISBCS method lowered QALY-cost by 24.6% and was also estimated to reduce the carbon footprint per eye by 29.2% compared to traditional ISBCS. Conclusions : This new method of performing ISBCS can potentially improve surgical productivity, reduce per-eye costs, lower QALY-cost, and significantly decrease carbon footprint, without compromising patient safety. It could thus serve as a preferred protocol for ISBCS in the future.