The Cost Utility of Strabismus Surgery in Adults

Beauchamp, Cynthia L.; Beauchamp, George R.; Stager, David R.; Brown, Melissa M.; Brown, Gary C.; Felius, Joost

doi:10.1016/j.jaapos.2006.06.004

« Previous Next »Journal of AAPOS
Volume 10, Issue 5 , Pages 394-399, October 2006

The Cost Utility of Strabismus Surgery in Adults

Cynthia L. Beauchamp, MD
- Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, Texas
George R. Beauchamp, MD
- Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, Texas
- Center for Evidence Based Medicine, Flourtown, Pennsylvania
David R. Stager Sr., MD
- Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, Texas
Melissa M. Brown, MD
- Center for Evidence Based Medicine, Flourtown, Pennsylvania
- Wills Eye Hospital, Philadelphia, Pennsylvania
Gary C. Brown, MD
- Center for Evidence Based Medicine, Flourtown, Pennsylvania
- Wills Eye Hospital, Philadelphia, Pennsylvania
Joost Felius, PhD
- Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, Texas
- Retina Foundation of the Southwest, Dallas, Texas
- Reprint requests: Dr. Joost Felius, PhD, Retina Foundation of the Southwest, 9900 N. Central Expressway, Suite 400, Dallas, TX 75231.

Received 6 April 2006; accepted 19 June 2006.

Purpose

Cost-utility analysis evaluates the cost of medical care in relation to the gain in quality-adjusted life years (QALYs). Our purpose was to develop a cost model for surgical care for adult strabismus, to estimate the mean cost per case, to determine the associated gain in QALYs, and to perform cost-utility analysis.

Methods

A cost model incorporated surgery, pre- and postoperative care, and a mean of 1.5 procedures per patient. The gain in QALYs was based on the improvement of utility on a scale from 0 (death) to 1 (perfect health). Utility was measured through physician-conducted interviews employing a time tradeoff question (seeking to estimate the portion of life expectancy a patient would be willing to trade for being rid of disease and associated effects). The interviews were conducted before and 5 to 8 weeks after surgery in 35 strabismic patients (age 19-75 years).

Results

The cost model resulted in an estimated total cost of $4,254 per case. A significant improvement of utility was found: 0.96 ± 0.11 postoperatively versus 0.85 ± 0.20 preoperatively (p = 0.00008). Based on the mean life expectancy (36.0 years) of these patients, and discounting outcomes and costs by 3% annually, this resulted in a mean value gain of 2.61 QALYs after surgery and a cost-utility for strabismus surgery of $1,632/QALY.

Conclusions

In the United States, treatments <$50,000/QALY are generally considered “very cost-effective.” Strabismus surgery in adults falls well within this range.