To perform a reference case cost-utility analysis of second-eye cataract surgery by using the current literature on cataract outcomes and complications.

Computer-based econometric modeling.

Visual acuity data of patients treated and observed over a 4-month postoperative period were obtained from the US National Cataract Patient Outcomes Research Team report. The results from this prospective study were combined with those of other studies that investigated the complication rates of cataract surgery to complete the cohort of patients and outcomes. These synthesized data were incorporated with time trade-off utility values, which accounted for prior successful cataract surgery in the fellow eye. Cost-utility determinations were made with decision analysis, and present value modeling was used to account for the time value of money and health state consequences.

The number of quality-adjusted life-years (QALYs) gained was calculated for the study group undergoing second-eye cataract surgery, assuming that the postoperative vision in the second eye was equivalent to the vision in the first eye after surgery (20/27). This was divided into the cost of the procedure to find the number of year 2001 nominal US dollars spent per QALY gained.

Second-eye cataract surgery, as compared with unilateral pseudophakia, resulted in a mean gain of 1.31 undiscounted QALYs per patient treated. A 3% annual discount rate, dependent on the duration of benefit, was used, yielding 0.92 discounted QALYs gained over a 12-year life expectancy. The mean discounted cost of treatment for each patient totaled 2509.ThecostdividedbytheQALYsgained(benefit)resultedin 2727 per QALY gained for this procedure. Sensitivity analysis varying costs and utility values revealed a range from 2045to 3649 per QALY gained.

Second-eye cataract surgery is an extremely cost-effective procedure when compared with other interventions across medical specialties. The cost-effectiveness of second-eye surgery diminishes only slightly from the 2023perQALYgainedfromfirst-eyecataractsurgery.Thissuggeststhatpatientswithgoodvisioninoneeyeandvisuallossfromcataractinthefelloweyederivesubstantialbenefitfromcataractextraction.