The Economic and Health Impact of Cataract Surgery Wait Times in Canada: A Cost‐Effective Analysis

Author Block: Matthew B. Schlenker 1, Isra Hussein 1, Tushar Srivastava 2, Jyoti Sharma 2, Iqbal Ike K. Ahmed 1. 1University of Toronto, 2ConnectHEOR Limited.
 

Author Disclosure Block:    M.B. Schlenker:   Any direct financial payments including receipt of honoraria; Name of for-profit or not-for-profit organization(s); Alcon, Allergan, Bausch Health, Johnson & Johnson Vision, Light Matter Interaction, Théa-Labtician, Santen.  I. Hussein:   Any direct financial payments including receipt of honoraria; Name of for-profit or not-for-profit organization(s); Alcon.  T. Srivastava:   Any direct financial payments including receipt of honoraria; Name of for-profit or not-for-profit organization(s); Alcon.  J. Sharma:   Any direct financial payments including receipt of honoraria; Name of for-profit or not-for-profit organization(s); Alcon.  I.K. Ahmed:   Any direct financial payments including receipt of honoraria; Name of for-profit or not-for-profit organization(s); Aequus, Ace Vision, Aerie Pharmaceuticals, Akorn, Alcon, Allergan, Aquea Health, Inc, ArcScan, Avellino Lab USA, Inc, Avisi, Bausch Health, Beaver Visitec, Beyeonics, Bionode, Carl Zeiss Meditec, Centricity Vision, Inc, CorNeat Vision, Custom Surgical, Elios Vision, ElutiMed, Equinox, eyeFlow, Inc, Exhaura Limited, Genentech, Glaukos, Gore, Heine, Heru, Iantrek, InjectSense, Iridex, iStar, Ivantis, Johnson & Johnson Vision, Labtician Thea, LayerBio, Leica Microsystems, Life Long Vision, Long, Bridge Medical, Inc, MicroOptx, MST Surgical, Myra Vision, New World Medical, NovaEye, Ocular Instruments, Ocular Therapeutix, Oculo, Oculus Surgical, Omega Ophthalmics, PolyActiva, PulseMedica, Radiance Therapeutics, Inc, Ripple Therapeutics, Sanoculis, Santen, Shifamed, LLC, Sight Sciences, Smartlens, Inc, Stroma, Thea Pharma, ViaLase, Visus Therapeutics, Vizzario, VSY Biotechnology, Zilia, Inc. Funded grants or clinical trials; Name of for-profit or not-for-profit organization(s); Aerie Pharmaceuticals, Alcon, Allergan, Bionode, Glaukos, iCare, Ivantis, Johnson & Johnson Vision, New World Medical, Santen.

Abstract Body: 

Purpose: Reducing cataract surgery (CS) wait times in Canada has been a longstanding
priority, with a 4‐month Pan‐Canadian benchmark unmet for more than 30% of patients. As
there is an associated patient and societal impact, a cost‐effectiveness analysis was conducted to
estimate and compare costs and health outcomes of different CS wait times in Canada. 

Study Design: Cost‐effectiveness analysis. 

Methods: A health economic Markov model was developed to estimate the cost‐effectiveness of 4‐month (benchmark) vs. 12‐month CS wait time for the first eye. To conceptualize and parametrize the model, a targeted literature review was performed. The model considered a societal perspective and evaluated both direct and indirect healthcare costs.
Health outcomes were estimated as quality adjusted life years (QALYs) from the health‐related
quality of life (HRQoL) of patients during the wait time and post‐surgery. Events related to falls and
crashes were also considered. A discount rate of 5% was applied to both costs and health outcomes.
Sensitivity analyses were performed to test model robustness. Scenario analysis to compare strategy
with shorter wait time of 1‐month vs 4‐month (benchmark) vs 12‐month was also conducted.
 

Results: The model estimated that CS wait time of 4 months (benchmark) lowered lifetime costs by
18% ($4,980 vs $6,102 CAD) and increased patient lifetime vision related QALYs by 0.16 versus 12‐
month wait time. The benchmark CS wait time also reduced falls by 48%, crashes by 51%,
productivity losses by 58%, and formal care visits by 58%. Scenario analysis with shorter wait time of
1‐month compared to 4‐months and 12‐months wait time showed a similar trend (decrease in costs
by 8% vs 4‐months and 25% vs 12‐months; increase in QALY by 0.06 vs 4‐months and 0.22 vs 12‐
months wait time). One‐way sensitivity analysis suggested that model results were most sensitive to
HRQoL changes during CS wait time. Probabilistic sensitivity analysis showed that the results are
stable under a wide range of assumptions. 

Conclusions: According to our model, a 4‐month CS wait time results in lower lifetime costs and improved patient QoL compared to a 12‐month wait time. To achieve such gains, a prioritization of stable funding would be necessary alongside a close collaboration between clinicians and Canadian health authorities.