Cost-effectiveness analysis of manual small incision cataract surgery (MSICS) and phacoemulsification (PE).

BACKGROUND: Cataract is the most common cause of blindness, responsible for 50 to 80% of all blindness in South-East Asia. Method of cataract surgery that has cost-effective, low technology procedure and a low complication rate in the shortest amount of time is needed. This study provides the useful resources comparing clinical outcomes and cost of phacoemulsification (PE) and manual small incision cataract surgery (MSICS) based on hospital perspective. OBJECTIVE: To compare the costs and effectiveness of two-cataract-surgery methods, MSICS and PE, using the hospital's perspective. SETTING: Department of Ophthalmology, Phrapoklao hospital, Thailand. MATERIAL AND METHOD: This study was prospective and comparative. Data was collected from medical charts and through patient interviews using data collection forms. Labor material and capital cost were recorded for both surgical methods. The effectiveness was measured in visual acuity (VA), astigmatism and complications occurring at 90 days after surgery. RESULTS: The average total cost was 10,043.81 bath/case for MSICS and 11,590.72 bath/case for PE. After 90 days after surgery, the average VA of MSICS and PE groups were 0.83 +/- 0.225 (0.10-1.00) and 0.76 +/- 0.268 (0.06-1.00). There was no statistically significant difference in both groups. The average astigmatism at 90 days after surgery was 1.01 +/- 0.733 (0.00-3.50) D and 0.99 +/- 0.713 (0.00-4.25) D for MSICS and PE method. The average change in astigmatism was 0.15 and 0.20 D for the MSICS and PE groups. The intraoperative complication was vitreous loss (1.40%) in the PE group. The postoperative complication was corneal edema (5.60%) in the MSICS group. There was no statistically significant difference in the number of postoperative complications in both groups (p = 0.16). CONCLUSION: The effectiveness of MSICS and PE methods was not significantly different, but PE method had higher costs. Therefore, MSICS has better cost-effectiveness than PE thus, MSICS should be a preferred cataract surgery method to PE method, based on the hospital's perspective.

A comparison of patient pain during cataract surgery with topical anesthesia in Prechop Manual Phacofragmentation versus phacoemulsification.

OBJECTIVE: To compare the pain level and complications during cataract surgery with topical anesthesia in Prechop MPF versus phacoemulsification. STUDY DESIGN: Prospective randomized comparative study. MATERIAL AND METHOD: One hundred patients, undergoing small incision cataract surgery under topical anesthesia, were allocated randomly to perform Prechop MPF (n = 50) or phacoemulsification (n = 50). Patients were asked to rate their pain level on a 10-point visual analog pain scale during the administration of the anesthetic, during the surgery and after surgery. The surgeon recorded his subjective assessment of patient cooperation and surgical complications. RESULTS: The mean pain score during surgery was 1.64 +/- 1.48 (SD) in the prechop MPF group and 0.92 +/- 1.34 (SD) in the phacoemulsification group. The difference between groups was statistically significant (p = .001). There was no significant difference in pain scores for delivery of anesthesia (p = .077), or after surgery (p = .221) and no significant difference in patient cooperation (p = .446) and surgical complications in either group. CONCLUSION: Patients having cataract surgery under topical anesthesia in the prechop MPF group had more intraoperative pain than patients in the phacoemulsification group. However there was no significant difference in patient cooperation and surgical complications between the groups.