Ophthalmologist In-Charge, Narela Polyclinic, North Delhi Municipal Corporation, Delhi, India.
Maulana Azad Medical College, Delhi, India.
Indian J Ophthalmol. 2022 Nov;70(11):3765-3770. doi: 10.4103/ijo.IJO_1266_22.
Cataract extraction is one of the most common surgical procedures performed worldwide. Manual small-incision cataract surgery (MSICS) is a popular technique of cataract extraction. Full economic evaluation of different techniques is of value to policy makers. This was a systematic review of published literature to present a brief overview of evidence available in respect of economic evaluation measures like cost effectiveness, cost utility, and cost parameters in cataract patients regarding MSICS. The data on these was sparse and heterogeneous. Direct costs of MSICS were lower than phacoemulsification (PE): $25.55 (PE) to $17.03 (MSICS) in India, $15 (MSICS) to $70 (PE) in Nepal, and $62.25 (MSICS) to $104.15 (PE) in Thailand. The cost utility analysis for MSICS demonstrated savings of $79.57 (INR6175) per gain in LogMAR BCVA, $8.91 (INR691) per QALY gained and $1.42 (INR110) per VF 14 score increment in India. Incremental cost-effectiveness ratio (ICER) $368.20 (13,215.50 Baht) for MSICS was better than $489.30 (17,561.70 Baht) for PE in Thailand. ICER for femto laser-assisted cataract surgery (FLACS) compared to was €10,703 in femtosecond laser-assisted versus phacoemulsification cataract surgery (FEMCAT) study. The corrected ICER for PE against MSICS is €146.50. The limited data available demonstrates that MSICS is the most cost-effective technique among FLACS, PE, and MSICS. MSICS scores over other existing alternatives of cataract extraction from cost-effectiveness and cost-minimization approaches. Further research is required in this area.
白内障摘出术是全球范围内最常见的手术之一。手动小切口白内障手术（MSICS）是一种广泛应用的白内障摘出技术。对不同技术的全面经济评估对于政策制定者具有重要价值。这是一项对已发表文献的系统综述，旨在简要概述 MSICS 患者在成本效益、成本效用和成本参数等经济评估措施方面的现有证据。关于这些方面的数据很少且存在异质性。MSICS 的直接成本低于超声乳化术（PE）：印度为$25.55（PE）比$17.03（MSICS），尼泊尔为$15（MSICS）比$70（PE），泰国为$62.25（MSICS）比$104.15（PE）。MSICS 的成本效用分析表明，在印度，每增加一个 LogMAR BCVA 视力单位可节省$79.57（INR6175），每获得一个 QALY 可节省$8.91（INR691），每增加一个VF 14 评分可节省$1.42（INR110）。泰国 MSICS 的增量成本效益比（ICER）$368.20（13,215.50 泰铢）优于 PE 的$489.30（17,561.70 泰铢）。与飞秒激光辅助白内障手术（FLACS）相比，在 Femto 激光辅助与超声乳化白内障手术（FEMCAT）研究中， Femto 激光辅助白内障手术的 ICER 为€10,703。PE 与 MSICS 的校正 ICER 为€146.50。现有数据有限，表明在 FLACS、PE 和 MSICS 中，MSICS 是最具成本效益的技术。MSICS 在成本效益和成本最小化方法方面优于其他现有的白内障摘出替代方案。该领域需要进一步研究。
