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

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.