COST EFFECTIVENESS ANALYSIS BETWEEN SMALL INCISION CATARACT SURGERY AND PHACOEMULSIFICATION

Abstract

Background: Cataract is the second priority eye disease in the world and this case in Indonesia occupies the third-highest position in Southeast Asia. There are two methods for cataract treatment that can be expensive, small incision method (SICS) and Phacoemulsification method, and it is important to know the cost-effective comparison of those two methods. 

Objective: This study aims to conduct Cost-Effectiveness Analysis (CEA) between cataract surgery; Small Incision Cataract Surgery (SICS) and Phacoemulsification, at Undaan Eye Hospital Surabaya. 

Materials and Method: A prospective study following up patients from before surgery up to 21 days’ post surgery. A total of 155 cataract patients had undergone surgery; 25 patients and 130 patients had SICS and Phacoemulsification, respectively. Quality-Adjusted Life Years (QALYs) was used as the outcome measure. The assessment of utility using ‘Visual Function 25’ (VF-25) was the quality of life regarding visual function before surgery, 7 days, and 21 days post-surgery. 

Result: The average cost of Phacoemulsification technique was Rp 10,821,038 and the average cost of SICS technique was Rp 10,443,544. QALYs at day7 post-surgery of Phacoemulsification and SICS was 9.49 and 8.95, respectively. While QALYs at day21 post- surgery of Phacoemulsification and SICS was 10.37 and 10.15, respectively. ICER values for Phacoemulsification versus SICS at day7 post-surgery was Rp 696,360 (USD 49,74) while at day 21 was Rp 1,723,559 (USD 123,11). 

Conclusion: Phacoemulsification and SICS are effective ways to improve the quality of life related to visual function. The incremental cost per QALYs obtained via Phacoemulsification from SICS at D7 and day21 post- surgery were less than Indonesia’s GDP per capita income of USD 3,347, means that Phacoemulsification is more cost effective than SICS technique for cataract surgery.