Surgical correction of strabismus in adult patients appears to be cost-effective, resulting in a cost-utility of less than $2,000 per quality-adjusted life year, according to a recent financial analysis.
Cynthia L. Beauchamp, MD, and colleagues at University of Texas Southwestern Medical Center, Dallas, and at Wills Eye Hospital, Philadelphia, conducted a cost-utility analysis of strabismus correction in 35 adult patients whose average age was 49 years. The study evaluated the cost of surgery in relation to the gain in quality of life it generated.
Before surgery, patients rated their expected improvement in quality of life, known as utility, as a numerical value from 0 to 1. The average rating was 0.85. After surgery, the mean utility rating increased significantly to 0.96 (P = .00008), according to Dr. Beauchamp and colleagues.
The researchers determined that surgical correction of strabismus results in an average overall gain of 2.61 quality-adjusted life years (QALYs), suggesting a significant effect over the estimated average 36 years of life remaining for these patients.
The researchers determined the average incremental cost of strabismus surgery in adults in 2005 to be $4,254 per case and $1,632 per QALY. This cost model included initial consultation fee, surgeon's fee, facility fee, anesthesia fee, postoperative drug costs and average complication costs.
"Cost-utility analyses form the foundation of value-based medicine, which connects evidence-based medicine to the field of health economics by incorporating cost and effectiveness measures (including utility) into its analyses," the study authors said.
"In the United States, treatments with an associated incremental cost-utility of less than $50,000 per QALY are generally considered 'very cost-effective,'" they said. "Based on the model and the measured utility gain, we demonstrated that strabismus surgery in adults is very cost-effective."
The utility data confirm the substantial negative effect of strabismus on adults' quality of life, the authors said. Preoperative utility scores were similar to those in patients with untreated unilateral amblyopia, diabetic retinopathy or age-related macular degeneration.
The study is published in the October issue of the Journal of the American Association for Pediatric Ophthalmology and Strabismus.