Skip to main content

Advertisement

SpringerLink
Log in

Cost-utility analysis of cataract surgery in Japan: a probabilistic Markov modeling study

  • Clinical Investigation
  • Published:
Japanese Journal of Ophthalmology Aims and scope Submit manuscript

Abstract

Objective

To evaluate with the best available clinical data in Japan the cost-effectiveness of cataract surgery through the estimation of the incremental costs per quality-adjusted life years (QALYs) gained.

Methods

A Markov model with a probabilistic cohort analysis was constructed to calculate the incremental costs per QALY gained by cataract surgery in Japan. A 1-year cycle length and a 20-year horizon were applied. Best available evidence in Japan supplied the model with data on the course of cataract surgery. Uncertainty was explored using univariate and probabilistic sensitivity analysis.

Results

In base case analysis, cataract surgery was associated with incremental costs of Japanese yen (¥) 551,513 (US$ 6,920) and incremental effectiveness of 3.38 QALYs per one cataract patient. The incremental cost effectiveness ratio (ICER) was ¥ 163,331 (US$ 2,049) per QALY.

In Monte Carlo simulation, the average patient with cataract surgery accrued 4.65 [95 % confidence interval (CI): 2.75–5.69] more QALYs than patients without surgery, giving an ICER of ¥ 118,460 (95 % CI: 73,516–207,926) (US$ 1,486) per QALY.

Conclusions

Cataract surgery in Japan is highly cost-effective even when allowing for the uncertainty of the known variability that exists in estimates of the costs, utilities, and postoperative complication rate.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Pascolini D, Mariotti SP. Global estimates of visual impairment: 2010. Br J Ophthalmol. 2012;96:614–8.

    Article  PubMed  Google Scholar 

  2. Ellwein LB, Urato CJ. Use of eye care and associated charges among the Medicare population: 1991–1998. Arch Ophthalmol. 2002;120:804–11.

    Article  PubMed  Google Scholar 

  3. Ministry of Health, Labour and Welfare. Survey of medical care activities in public health insurance 2008. Statistics and Information Department, Minister’s Secretariat; 2009.

  4. Ministry of Health, Labour and Welfare. National Medical Care Expenditure Estimates FY2009. Statistics and Information Department, Minister’s Secretariat, Ministry of Health, Labour and Welfare. 2011. http://www.mhlw.go.jp/toukei/saikin/hw/k-iryohi/09/toukei6.html. Accessed 7 July 2012.

  5. Yamada M, Hiratsuka Y, Roberts CB, Pezzullo ML, Yates K, Takano S, et al. Prevalence of visual impairment in the adult Japanese population by cause and severity and future projections. Ophthalmic Epidemiol. 2010;17:50–7.

    Article  PubMed  Google Scholar 

  6. Busbee BG, Brown MM, Brown GC, Sharma S. Incremental cost-effectiveness of initial cataract surgery. Ophthalmology. 2002;109:606–12.

    Article  PubMed  Google Scholar 

  7. Kobelt G, Lundström M, Stenevi U. Cost-effectiveness of cataract surgery. Method to assess cost-effectiveness using registry data. J Cataract Refract Surg. 2002;28:1742–9.

    Article  PubMed  Google Scholar 

  8. Räsänen P, Krootila K, Sintonen H, Leivo T, Koivisto AM, Ryynänen OP, et al. Cost-utility of routine cataract surgery. Health Qual Life Outcomes. 2006;74:1–11.

    Google Scholar 

  9. Lansingh VC, Carter MJ, Martens M. Global cost-effectiveness of cataract surgery. Ophthalmology. 2007;114:1670–8.

    Article  PubMed  Google Scholar 

  10. Takura T, Oshika T, Miyake K, Ozawa T, Yamashita H. Socioeconomic evaluation of cataract and intraocular lens surgery by cost-rate and cost-utility analysis (article in Japanese). Jpn J Ophthalmol Surg. 2009;22:67–76.

    Google Scholar 

  11. Naeim A, Keeler EB, Gutierrez PR, Wilson MR, Reuben D, Mangione CM. Is cataract surgery cost-effective among older patients with a low predicted probability for improvement in reported visual functioning? Med Care. 2006;44:982–9.

    Article  PubMed  Google Scholar 

  12. Hiratsuka Y, Yamada M, Murakami A, Okada AA, Yamashita H, Ohashi Y, et al. Eye Care Comparative Effectiveness Research Team (ECCERT) Cost-effectiveness of cataract surgery in Japan. Jpn J Ophthalmol. 2011;55:333–42.

    Article  PubMed  Google Scholar 

  13. König HH, Barry JC. Cost effectiveness of treatment for amblyopia: an analysis based on a probabilistic Markov model. Br J Ophthalmol. 2004;88:606–12.

    Article  PubMed  Google Scholar 

  14. Yamada M, Mizuno Y, Miyake Y, Cataract Survey Group of the National Hospital Organization of Japan. A multicenter study on the health-related quality of life of cataract patients: baseline data. Jpn J Ophthalmol. 2009;53:470–6.

    Article  PubMed  Google Scholar 

  15. Abridged life tables for 2009 in Japan. http://www.mhlw.go.jp/toukei/saikin/hw/life/life09/index.html. Accessed 5 July 2012).

  16. Shimazaki J, Amano S, Uno T, Maeda N, Yokoi N, the Japan Bullous Keratopathy Study Group. National survey on bullous keratopathy in Japan. Cornea. 2007;26:274–8.

    Article  PubMed  Google Scholar 

  17. Kurosaka D, Oguchi Y, Hosaka D, Kitahara K. Clinical evaluation of soft acrylic colored intraocular lens (AANV). IOL RS. 2005;19:331–8. (in Japanese).

    Google Scholar 

  18. Boku C, Onisi T, Kizaki H, Yaguchi S. Repositioning or removal of dislocated posterior chamber lenses. Jpn J Clin Ophthalmol. 1995;49:1119–22. (in Japanese).

    Google Scholar 

  19. Atsumi K, Tanaka H, Ogino N. Inflammation following posterior chamber lens implantation (in vs. out of the bag). J Eye (Atarashii Ganka). 1993;10:154–6 (in Japanese).

    Google Scholar 

  20. Inoue Y, Mitoshi T, Fujita Y, Inamura M, Sugiura T, Fujita Y, Inamura M, Sugiura T. The incidence of postoperative endophthalmitis after phacoemulsification with temporal corneal incision. Ophthalmology. 2005;47:1853–7.

    Google Scholar 

  21. Kamikura Y, Shimizu K, Takano M, Amano R, Komatsu M, Naruse R. Incidence of endophthalmitis following temporal corneal incision cataract surgery. IOL RS. 2008;22:217–21. (in Japanese).

    Google Scholar 

  22. Nishimura E, Yaguchi S, Kageyama T. Visual results of endophthalmitis after phacoemulsification using early capsular bag wash out technique and/or vitrectomy. Jpn J Ophthalmic Surg. 2004;17:83–7. (in Japanese).

    Google Scholar 

  23. Shimizu N, Shimizu K. Incidence and prevention of endophthalmitis following cataract surgery. Jpn J Clin Ophthalmol. 1997;51:211–4 (in Japanese).

    Google Scholar 

  24. Tanaka S, Shimada Y, Ochiai Y, Ochiai H, Yamanaka H. Therapeutic outcome of acute endophthalmitis following intraocular lens implantation. Jpn J clin Ophthalmol. 2004;58:1077–80. (in Japanese).

    Google Scholar 

  25. Yasuma T, Miura M, Yasuma M, Miyakawa N, Hirai Y, Anno M. Two cases of postoperative infection in a consecutive 13,000 cases of cataract surgery. Influence of cleanliness of surgical theater and duration of surgery. Jpn J Clin Ophthalmol. 2004;58:449–4 (in Japanese).

    Google Scholar 

  26. Yoshida S, Hashimoto H, Tsuchiya H, Obara Y. The prognosis of posterior capsule rupture cases. IOL. 1993;7:20–6. (in Japanese).

    Google Scholar 

  27. Inomata K, Satoh Y. YAG laser capsulotomy frequency after PCL implantation: a comparison of sixteen manufactures. J Surg Ophthalmol. 1992;5:671–6. (in Japanese).

    Google Scholar 

  28. Matsumoto C, Iwanishi R, Saito K. Cataract surgery at the Miyoshi kosei Hospital. Jpn Rev Clin Ophthalmol. 2007;101:285–9. (in Japanese).

    Google Scholar 

  29. Miki E, Segawa M, Hirokawa C. Gannailenzu ni yoru kouhatsuhakunaisyou yokuseikouka no hikaku. J Eiju Gen Hosp. 2005;17:64–9 (in Japanese).

    Google Scholar 

  30. Oohashi F, Majima K, Takeuchi T, Majima Y, Horiguchi M. Relation between after cataract incidence and foldable IOL material implantation. J Eye (Atarashii Ganka). 1999;16:117–20. (in Japanese).

    Google Scholar 

  31. Onishi T, Kora Y, Kizaki H, Yaguchi S. Comparative study of silicone lens and small optic PMMA lens in regard to after-cataract. Jpn J Ophthalmic Surg. 1995;8:47–51. (in Japanese).

    Google Scholar 

  32. Takenobu J, Kita Y, Nishi O. Posterior capsular opacification after implantation of posterior chamber lens with an open-circular haptic. IOL RS. 1997;11:25–8. (in Japanese).

    Google Scholar 

  33. Uchino Y, Kurosaka D, Yoshino M, Nakamura K, Katou K, Negishi K. Effect of polymethylmethacrylate, hydrogel, and polyacrylic intraocular lenses on posterior capsular opacification. J Eye (Atarashii Ganka). 2003;20:1297–300. (in Japanese).

    Google Scholar 

  34. Usui M, Uehara R, Matsuura G, Sanada A, Abe A, Ohta T, et al. Long-term follow-up of 465 eyes with posterior chamber lenses implanted by extracapsular cataract extraction with continuous circular capsulorhexis and the double-hook technique. Jpn Rev Clin Ophthalmol. 1991;85:806–12. (in Japanese).

    Google Scholar 

  35. Yoshida S, Meya C, Okada Y, Matsushima H, Senoo T. The results of the intraocular lens for micro incision cataract surgery. Jpn J Ophthalmol Surg. 2009;22:231–4. (in Japanese).

    Google Scholar 

  36. Takeshita T. Comparison of outcome after implantation of two intraocular lenses with same design and different material. Jpn J Clin Ophthalmol. 2007;61:399–401. (in Japanese).

    Google Scholar 

  37. Hanazaki H. The shape of optic edge and posterior cataract in silicone intraocular lens. Jpn J Ophthalmic Surg. 2004;17:75–8. (in Japanese).

    Google Scholar 

  38. Uchida M, Ogura Y, Masuda A, Matsumura M, Honda Y. Clinical characteristics and surgical results of pseudophakic rhegmatogenous retinal detachment. Jpn J Ophthalmic Surg. 1994;7:81–3. (in Japanese).

    Google Scholar 

  39. Chikuta M, Tsuchiya H, Kadoya K, Obara Y. Retinal detachment surgery in pseudophakic eye. Jpn J Clin Ophthalmol. 1992;46:712–3. (in Japanese).

    Google Scholar 

  40. Fujii Y, Watanabe T, Kanaya Y, Kubo M, Shiji E, Watanabe N, et al. Vitreous surgery in pseudophakic eyes. Jpn Rev Clin Ophthalmol. 1998;92:1291–5. (in Japanese).

    Google Scholar 

  41. Manabe S, Kita M, Oguchi Y, Honda Y. Prognosis of dislocated posterior intraocular lenses. Jpn J Ophthalmic Surg. 1995;8:301–5. (in Japanese).

    Google Scholar 

  42. Yawata K, Haruki T, Ito K. Therapeutic outcome of endophthalmitis following cataract surgery. Jpn J Clin Ophthalmol. 2009;63:981–5. (in Japanese).

    Google Scholar 

  43. Ninomiya Y, Hirakata A, Hiraoka T, Kunita D, Inoue M, Oshitari K, et al. Clinical Features of endophthalmitis after cataract surgery evaluated by the presence of background factors. J Jpn Ophthalmol Soc. 2007;112:525–30. (in Japanese).

    Google Scholar 

  44. Usui N, Uno T, Oki K, Oshika T, Ohashi Y, Ogura Y, et al. Nationwide surveillance of postoperative endophthalmitis related to cataract surgery. Jpn J Ophthalmic Surg. 2006;19:73–9. (in Japanese).

    Google Scholar 

  45. Onda H, Koide R, Fujisawa K, Shimizu K, Iwabuchi S, Totsuka N. Intracapsular bag washout after cataract surgery. IOL RS. 2005;19:60–5. (in Japanese).

    Google Scholar 

  46. Nakaguma S, Matsumoto K, Hirata A, Inada K, Negi A. Bacterial endophthalmitis following cataract surgery. Jpn J Clin Ophthalmol. 2003;57:1481–5. (in Japanese).

    Google Scholar 

  47. Oshitari K, Hirakata A, Okada AA, Hida T, Oda H, Miki D, et al. Vitrectomy for endophthalmitis after cataract surgery. J Jpn Ophthalmol Soc. 2003;107:590–6. (in Japanese).

    Google Scholar 

  48. Murakami K, Yoshozawa T, Ando H, Abe T, Imai K, Sasagawa T, et al. Vitrectomy for postoperative endophthalmitis after cataract surgery. Jpn J Ophthalmic Surg. 1998;11:489–92. (in Japanese).

    Google Scholar 

  49. Kume Y, Tanaka M, Ninomiya H, Kobayashi Y. Vitrectomy for endophthalmitis following cataract surgery. J Eye (Atarashii Ganka). 1998;15:1159–61. (in Japanese).

    Google Scholar 

  50. Nakashizuka H, Shimada H, Yuzawa M, Arai S. Investigation of the incidence rate of endophthalmitis and the bacterial contamination rate of the anterior chamber after phacoemulsification cataract surgery. Jpn J Ophthalmic Surg. 2007;20:409–12. (in Japanese).

    Google Scholar 

  51. Aonuma H. Endophthalmitis following cataract surgery in our institution and associated hospitals. Jpn J Clin Ophthalmol. 1999;53:815–8. (in Japanese).

    Google Scholar 

  52. Matsuura T, Matsuo K, Kageyama M, Matsumoto CS, Nakatsuka K. Ocular complications after intraocular implantation. Review of hospitalized cases. Jpn Rev Clin Ophthalmol. 1995;89:1079–82 (in Japanese).

    Google Scholar 

  53. Hayama A, Tsuneoka H, Shiba T, Kitahara K. Difference in intraocular lens optic edge design and incidence of posterior capsule opacification. IOL RS. 2006;20:37–42 (in Japanese).

    Google Scholar 

  54. Obara Y, Shouji E, Sugita G. Clinical evaluation of ultraviolet-absorbing single-piece posterior chamber intraocular lens (HOYA UV-1 P). Jpn Rev Clin Ophthalmol. 1994;88:752–6. (in Japanese).

    Google Scholar 

  55. Nakao F, Hayashi F, Ohyabu Y, Hayashi H. Q-switched Nd:YAG laser posterior capsulotomy. Jpn J Clin Ophthalmol. 1984;38:127–32. (in Japanese).

    Google Scholar 

  56. Takahashi K, Chiba K, Senoo T, Ota S, Obara Y. Results of penetrating keratoplasty for aphakic and pseudophakic bullous keratopathy. J Eye. 1998;15:1003–6. (in Japanese).

    Google Scholar 

  57. Oshitari K, Mashima Y, Idei K, Nii S. Effect on vision of penetrating keratoplasty for pseudophakic bullous keratopathy after posterior chamber lens implantation. Folia Ophthalmol Jpn. 1995;46:849–53. (in Japanese).

    Google Scholar 

  58. Mori A, Idei T, Nii S, Mashima Y. Results of penetrating keratoplasty for pseudophakic bullous keratopathy. Jpn J Ophthalmic Surg. 1995;8:653–6. (in Japanese).

    Google Scholar 

  59. Mönestam EI. Incidence of dislocation of intraocular lenses and pseudophakodonesis 10 years after cataract surgery. Ophthalmology. 2009;116:2315–20.

    Article  PubMed  Google Scholar 

  60. Erie JC, Raecker ME, Baratz KH, Schleck CD, Robertson DM. Risk of retinal detachment after cataract extraction, 1980–2004: a population-based study. Trans Am Ophthalmol Soc. 2006;104:167–75.

    PubMed  Google Scholar 

  61. Briggs AH, Gray AM. Handling uncertainty when performing economic evaluation of healthcare interventions. Health Technol Assess. 1999;3:1–134.

    PubMed  CAS  Google Scholar 

  62. Oshika T, Nagahara K, Yaguchi S, Emi K, Takenaka H, Tsuboi S, et al. Three year prospective, randomized evaluation of intraocular lens implantation through 3.2 and 5.5 mm incisions. J Cataract Refract Surg. 1998;24:509–14.

    Article  PubMed  CAS  Google Scholar 

  63. Powe NR, Schein OD, Gieser SC, Tielsch JM, Luthra R, Javitt J, et al. Synthesis of the literature on visual acuity and complications following cataract extraction with intraocular lens implantation. Cataract Patient Outcome Research Team. Arch Ophthalmol. 1994;112:239–52.

    Article  PubMed  CAS  Google Scholar 

  64. Shiroiwa T, Sung YK, Fukuda T, Lang HC, Bae SC, Tsutani K. International survey on willingness-to-pay (WTP) for one additional QALY gained: what is the threshold of cost effectiveness? Health Econ. 2010;19:422–37.

    Article  PubMed  Google Scholar 

  65. Phillips CJ. Health Economics: and introduction for health professionals. Malden: Blackwell Publishing; 2005.

    Book  Google Scholar 

  66. Muenning P. Cost-effectiveness analysis in health. San Francisco: Jossey-Bass; 2008.

    Google Scholar 

  67. Sonnenberg FA, Beck JR. Markov models in medical decision making: a practical guide. Med Decis Mak. 1993;13:322–38.

    Article  CAS  Google Scholar 

  68. Lansingh VC, Carter MJ. Use of global visual acuity data in a time trade-off approach to calculate the cost utility of cataract surgery. Arch Ophthalmol. 2009;127:1183–93.

    Article  PubMed  Google Scholar 

  69. Busbee BG, Brown MM, Brown GC, Sharma S. Cost-utility analysis of cataract surgery in the second eye. Ophthalmology. 2003;110:2310–7.

    Article  PubMed  Google Scholar 

  70. Medial fees 2011. Los Angeles: Practice Management Information Corporation; 2011.

  71. Fattore G, Torbica A. Cost and reimbursement of cataract surgery in Europe: a cross-country comparison. Health Econ. 2008;17 Suppl 1:S71–82.

    Google Scholar 

  72. Ubel PA, Hirth RA, Chernew ME, Fendrick AM. What is the price of life and why doesn’t it increase at the rate of inflation? Arch Intern Med. 2003;163:1637–41.

    Article  PubMed  Google Scholar 

  73. Detsky AS, Laupacis A. Relevance of cost-effectiveness analysis to clinicians and policy makers. JAMA. 2007;298:221–4.

    Article  PubMed  CAS  Google Scholar 

  74. Euro Qol Group. EuroQol; a new facility for the measurement of health-related quality of life. Health Policy. 1990;16:199–208.

    Article  Google Scholar 

  75. Furlong WJ, Feeny DH, Torrance GW, Barr RD. The Health Utilities Index (HUI) system for assessing health-related quality of life in clinical studies. Ann Med. 2001;33:375–84.

    Article  PubMed  CAS  Google Scholar 

  76. Brown MM, Brown GC, Sharma S. Evidence-based to value-based medicine. Chicago: American Medical Association Press; 2005.

    Google Scholar 

  77. Sharma S, Brown GC, Brown MM, Hollands H, Robins R, Shah GK. Validity of the time trade-off and standard gamble methods of utility assessment in retinal patients. Br J Ophthalmol. 2002;86:493–6.

    Article  PubMed  CAS  Google Scholar 

  78. Brown GC, Brown MM, Sharma S, Beauchamp G, Hollands H. The reproducibility of ophthalmic utility values. Trans Am Ophthalmol Soc. 2001;99:199–203.

    PubMed  CAS  Google Scholar 

  79. Tengs TO, Wallace A. A thousand health-related quality-of-life estimates. Med Care. 2000;38:583–637.

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgments

This study was funded by research grants from the Japan National Society for the Prevention of Blindness.

Author information

Authors and Affiliations

    Consortia

    Eye Care Comparative Effectiveness Research Team (ECCERT)

    Additional information

    This article is from the Eye Care Comparative Effectiveness Research Team (ECCERT). Address correspondence to: Yoshimune Hiratsuka, Department of Health and Welfare Services, National Institute of Public Health, 2-3-6 Minami, Wako, Saitama 351-0197, Japan, e-mail: yoshi-h@tkf.att.ne.jp

    Appendix

    Appendix

    The Eye Care Comparative Effectiveness Research Team (ECCERT)

    The following individuals participated in the study.

    Corresponding author: Yoshimune Hiratsuka

    Writing Committee: Yoshimune Hiratsuka, Masakazu Yamada, Yoko Akune, Akira Murakami, Annabelle A. Okada, Hidetoshi Yamashita, Yuichi Ohashi, Naoya Yamagishi, Hiroshi Tamura, Shunichi Fukuhara, Tomoyuki Takura.

    The Study Group Investigators and the Clinical Sites: Eguchi Ganka Hospital, Hokkaido: Shuichiro Eguchi.

    Iwate Medical University, Iwate: Daijiro Kurosaka.

    Yamagata University, Yamagata: Hidetoshi Yamashita. National Hospital Organization Tokyo Medical Center, Tokyo: Masakazu Yamada.

    Kyorin University School of Medicine, Tokyo: Annabelle A. Okada.

    Juntendo University School of Medicine, Tokyo: Akira Murakami, Koichi Ono.

    Juntendo Tokyo Koto Geriatric Medical Center, Tokyo: Yoshimune Hiratsuka, Kenichi Takahashi.

    Shohzankai Medical Foundation Miyake Eye Hospital, Nagoya: Sampei Miyake.

    National Hospital Organization Nagoya Medical Center, Nagoya: Hiroshi Hirose.

    National Hospital Organization Osaka Medical Center, Osaka: Yasumasa Otori.

    Kyoto University, Kyoto: Nagahisa Yoshimura, Hiroshi Tamura.

    Ehime University, Ehime: Yuichi Ohashi, Toshihiko Uno, Yasuaki Yamamoto.

    Central Unit: National Institute of Sensory Organs, National Hospital Organization Tokyo Medical Center, Tokyo: Yoko Akune, Masakazu Yamada.

    About this article

    Cite this article

    Eye Care Comparative Effectiveness Research Team (ECCERT). Cost-utility analysis of cataract surgery in Japan: a probabilistic Markov modeling study. Jpn J Ophthalmol 57, 391–401 (2013). https://doi.org/10.1007/s10384-013-0238-8

    Download citation

    • Received:

    • Accepted:

    • Published:

    • Issue Date:

    • DOI: https://doi.org/10.1007/s10384-013-0238-8

    Keywords

    Search

    Navigation