As pressures mount to contain the cost of health care, particularly when more people are expected to live longer, it is reasonable to look critically at the “return on investment” (ROI) and see where cataract surgery compares to other frequently performed procedures that account for substantial health care dollars. The most common method of looking at cost-utility or cost-effectiveness is the use of the QALY or quality-adjusted life year which addresses the “area under the curve” – assessing both increased quality of life and extended duration of life. For example, a year of perfect health gets a score of 1.0 while death receives a score of 0. Extending an unhealthy life for a year earns an intermediate score. Applying cost utility analysis to QALY yields a ratio with lower cost representing a better ROI or cost-effective medical intervention.
In studies performed within the past decade, the estimated cost per QALY gained per procedure (per eye) was $4500 (US dollars in 2002) in a Swedish study and $2023 in a similar US study. The lower the cost the better and this compares favorably to single vessel CABG at $7000/QALY, HTN treatment at $58,000/QALY, and peritoneal dialysis at $90,000. In a fascinating study by Cutler and McClellan that asked “is technological change in medicine worth it?’ – They estimated the value of cataract surgery at $95,000, much greater than the actual cost of the procedure. The higher the value the better and this compares favorably to other value estimates such as treatment for breast cancer ($20,000), depression ($6000), heart attack ($70,000), and care of a low birthweight infant ($240,000).