COST EFFECTIVENESS OF EARLIER CATARACT SURGERY TO PREVENT MOTOR VEHICLE COLLISIONS

Purpose: To determine the optimal time for cataract surgery in regard to reducing the frequency of motor vehicle collisions.

Method: Using data from the Impact of Cataracts on Mobility (ICOM) study and related databases, simulation modeling is used to examine how many motor vehicle collisions and deaths might be avoided if a threshold measure of vision, contrast sensitivity, were to determine when cataract surgery ought to be performed. The cost effectiveness of such earlier cataract surgery is examined from a societal perspective. Motor vehicle collision rates have been shown to fall approximately by half for elderly drivers after cataract surgery. Currently, most insurers allow payment for cataract surgery based upon an individual's self-reported visual difficulties or adverse visual symptoms. As a consequence, surgery tends to occur some time after significant vision problems have emerged.

Result: Because cataract surgery improves the quality of life of the individual, results suggest that the incremental cost per quality adjusted life year for earlier cataract surgery is highly favorable in a range below $1,000 per QALY.  Whether earlier surgery is cost saving depends upon the frequency and severity of collisions prevented and the mortality rate of the age group considered.  Most often, the collision that is prevented is a minor “fender bender” with costs roughly equivalent to cataract surgery. Thus earlier surgery appears to be cost saving only when the collisions prevented exceed currently observed levels of frequency and severity or when mortality rates in the population are low or improving because this gives enough people time to earn back, through lower collisions, the cost of their surgery.

Conclusion: Performing cataract surgery earlier than under standard guidelines is likely to have low incremental cost per quality adjusted life year gained.