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Is there overutilisation of cataract surgery in England?

Black, N., Browne, J., van der Meulen, J.H., Jamison, L., Copley, L.P., and Lewsey, J. (2009) Is there overutilisation of cataract surgery in England? British Journal of Ophthalmology, 93 . pp. 13-17. ISSN 0007-1161 (doi:10.1136/bjo.2007.136150 )

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Publisher's URL: http://dx.doi.org/10.1136/bjo.2007.136150

Abstract

Objectives: Following a 3.7-fold increase in the rate of cataract surgery in the UK between 1989 and 2004, concern has been raised as to whether this has been accompanied by an excessive decline in the threshold such that some operations are inappropriate. The objective was to measure the impact of surgery on a representative sample of patients so as to determine whether or not overutilisation of surgery is occurring. Design: Prospective cohort assessed before and 3 months after surgery. Setting: Ten providers (four NHS hospitals, three NHS treatment centres, three independent sector treatment centres) from across England. Participants: 861 patients undergoing first eye (569) or second eye (292) cataract surgery provided preoperative data of whom 745 (87%) completed postoperative questionnaires. Main outcome measures: Patient-reported visual function (VF-14); general health status and quality of life (EQ5D); postoperative complications; overall view of the operation and its impact. Results: Overall, visual function improved (mean VF-14 score increased from 83.2 (SD 17.3) to 93.7 (SD 13.2)). Self-reported general health status deteriorated (20.3% fair or poor before surgery compared with 25% afterwards) which was reflected in the mean EQ5D score (0.82 vs 0.79; p = 0.003). At least one complication was reported by 66 (8.9%) patients, though this probably overestimated the true incidence. If the appropriateness of surgery is based on an increase in VF-14 score of 5.5 (that corresponds to patients’ reporting being "a little better"), 30% of operations would be deemed inappropriate. If an increase of 12.2 (patients’ reports of being "much better") is adopted, the proportion inappropriate is 49%. Using a different approach to determining a minimally important difference, the proportion inappropriate would be closer to 20%. Although visual function (VF-14) scores were unchanged or deteriorated in 25% of patients, 93.1% rated the results of the operation as "good," "very good" or "excellent," and 93.5% felt their eye problem was "better." This partly reflects inadequacies in the validity of the VF-14. Conclusions: Improvement in the provision of cataract surgery has been accompanied by a reduction in the visual function threshold. However, methodological difficulties in measuring the impact of cataract surgery on visual function and quality of life mean it is impossible to determine whether or not overutilisation of cataract surgery is occurring. N Black1, J Browne1, J van der Meulen1, L Jamieson2, L Copley2 and J Lewsey3

Item Type:Article
Status:Published
Refereed:Yes
Glasgow Author(s):Lewsey, Dr James
Authors: Black, N., Browne, J., van der Meulen, J.H., Jamison, L., Copley, L.P., and Lewsey, J.
Subjects:R Medicine > RE Ophthalmology
R Medicine > RD Surgery
R Medicine > RA Public aspects of medicine
College/School:College of Medical Veterinary and Life Sciences > School of Medicine > Centre for Population and Health Sciences
College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > Health Economics and Health Technology Assessment
Journal Name:British Journal of Ophthalmology
Publisher:BMJ Publishing Group
ISSN:0007-1161
Copyright Holders:Copyright © 2006 BMJ Publishing Group
First Published:First published in British Journal of Ophthalmology 93:13-17
Publisher Policy:Reproduced in accordance with the copyright policy of the publisher.

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