Immediate bilateral cataract surgery is more cost-effective with similar outcomes compared to delayed sequential surgery

1. Target refractive outcome was achieved in 97% of ISBCS and 98% of DSBCS patients.

2. Societal costs for ISBCS were $507 (€403) lower, on average, compared to DSBCS.

Evidence Rating Level: 1 (Excellent)

Study Rundown: Cataract surgery accounts for a large proportion of age-related visual surgeries worldwide. Delayed sequential bilateral cataract surgery (DSBCS) is the current standard of care, though this is associated with a longer recovery time and more frequent hospital visits compared to the newer, but lesser performed immediate sequential bilateral cataract surgery (ISBCS). This randomized controlled trial aimed to assess the safety, efficacy, and cost-effectiveness of ISBCS versus DSBCS. The primary outcome was the proportion of second eyes achieving a target refractive outcome ≤ 1.0 dioptre (D) while the key secondary outcome included a target refractive outcome ≤ 0.5 D. According to study results, ISBCS was non-inferior to DSBCS with regards to the primary outcome. In addition, patients who underwent ISBCS reported comparable safety and superior cost-effectiveness. The proportion of second eyes meeting the target refractive outcome was similar in both groups. A major limitation of the study was a lack of masking due to the nature of the intervention.

Click to read the study in The Lancet

Relevant Reading: Preoperative Medical Testing in Medicare Patients Undergoing Cataract Surgery

In-depth [randomized-controlled trial]: Between Sept 4, 2019, and Jul 10, 2020, 865 patients were screened for eligibility across 10 Dutch hospitals. Included were patients ≥ 18 years with uncomplicated cataract surgery and no increased risk of endophthalmitis. Altogether, 811 patients (404 in ISBCS and 407 in DSBCS) were included in the intention-to-treat analysis. The primary outcome of second eyes achieving a target refractive outcome ≤ 1.0 D was comparable in both groups (97% in ISBCS and 98% in DSBCS). This was also the case for adverse events between groups with the only significant difference being anisometropia (p=0.0001). ISBCS was US $507 cheaper than DSBCS with 100% cost-effectiveness. Findings from this study suggest that ISBCS is non-inferior to DSBCS regarding safety, efficacy, and cost-effectiveness.

Image: PD

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