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Economic Evaluation of Alternative Programs of Reduced-Stay Senile Cataract Surgery

Published online by Cambridge University Press:  29 November 2010

Ronald Wall
Affiliation:
University of Manitoba
Stephen Birch
Affiliation:
McMaster University
Millie McQuillin
Affiliation:
St. Mary's General Hospital, Kitchener*

Résumé

Chez les aînés, les cataractes séniles sont une des causes principales des diverses incapacités dues à la cécité. Le nombre de chirurgies pour des cataractes, opération permettant au patient de recouvrer la vue, augmentera probablement compte tenu du vieillissement de la population canadienne, des attentes grandissantes des patients et des progrès technologiques. Une des méthodes suggérées pour améliorer l'efficacité du traitement serait de réduire la durée traditionnelle du séjour post-opératoire. Cet article examine l'efficacité clinique et détermine le coût de différentes modalités de soins post-opératoires, du point de vue du système ontarien de soins de santé, des patients, de leurs aides, et de la société. Les coûts et les conséquences sont comparés en utilisant une méthodologie analytique de minimisation de côuts. Bien qu'un séjour post-opératoire écourté semble permettre de réaliser des économies, les conséquences distributionnelles qui surviennent lorsque le séjour post-opératoire à l'hôpital est remplacé par les soins à domicile pourraient ralentir son adoption. Dans le but d'éviter ces conséquences distributionnelles, il faudrait déduire les sommes destinées préalablement aux hôpitaux et les confier aux agences de soins communautaires et aux aides des patients. Compte tenu du fait qu'une chirurgie pratiquée dans un service de consultation externe semble être tout aussi efficace qu'une chirurgie pratiquée en milieu hospitalier, les responsables politiques devraient étudier les stratégies qui permettraient de bénéficier de ces économies possibles.

Type
Articles
Copyright
Copyright © Canadian Association on Gerontology 1991

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References

1.Leske, M, Sperduto, R.The epidemiology of senile cataracts: A review. American Journal of Epidemiology 1983; 118: 152–65.CrossRefGoogle ScholarPubMed
2.Sommer, A.Cataracts as an epidemiologic problem. American Journal of Ophthalmology 1977; 83: 334–9.CrossRefGoogle ScholarPubMed
3.Applegate, W, Miller, S, Elam, J, et al. Impact of cataract surgery with lens implantation on vision and physical function in elderly patients. Journal of the American Medical Association 1987; 257: 1064–6.CrossRefGoogle ScholarPubMed
4.Oxford Cataract Treatment and Evaluation Team. I. Cataract surgery: Interim results and complications of a randomised controlled trial. British Journal of Ophthalmology 1986; 70: 402–10.CrossRefGoogle Scholar
5.Davies, L, Drummond, M, Woodward, E, Buckley, R.A cost-effectiveness comparison of intraocular lens and the contact lens in aphakia. Transactions of the Ophthalmology Society of the United Kingdom 1986; 105: 304–13.Google ScholarPubMed
6.Statistics Canada. Health reports supplement: Surgical procedures and treatments 1983–1984, 1984–1985. Ottawa: Minister of Supplies and Services, 1989.Google Scholar
7.Statistics Canada. Health reports supplement: Surgical procedures and treatments 1985–1986. Ottawa: Minister of Supplies and Services, 1989.Google Scholar
8.Keltner, J, Johnson, C. Visual function, driving, safety, and the elderly. Ophthalmology 1987; 94: 1180–8.CrossRefGoogle ScholarPubMed
9.Nadler, D, Schwartz, B. Cataract surgery in the United States, 1968–1976: A descriptive epidemiologie study. Ophthalmology 1980; 87: 1018.CrossRefGoogle Scholar
10.Dowling, J. Ambulatory cataract surgery. In: Waltman, S, Keats, R, Hoyt, C, et al. eds. Surgery of the eye. New York: Churchill Livingstone, 1988.Google Scholar
11.Stark, W, Leske, M, Worthen, D, Murray, G. Trends in cataract surgery and intraocular lenses in the United States. American Journal of Ophthalmology 1983; 96: 304–10.CrossRefGoogle ScholarPubMed
12.Taylor, J. Medicare payments and changes in the rate of cataract extraction. Ophthalmology 1981; 88: 41A–6A.Google ScholarPubMed
13.Philipson, B. Visual rehabilitation for the elderly through improved surgical technology. International Journal of Health Care Technology Assessment 1985; 1: 8591.CrossRefGoogle Scholar
14.Shah, C, Peachey, G. Day-case surgery in the hospital. In: Pascarelli, E. ed. Hospital based ambulatory care. Norwalk: Appleton-Century-Crofts, 1982.Google Scholar
15.McPhillips, R. Can the elderly afford eye care? Can we afford eye care for the elderly?. Ophthalmology 1987; 94: 1199–204.CrossRefGoogle ScholarPubMed
16.Wilson, J. Clearing the cataract backlog. British Journal of Ophthalmology 1987; 71: 158–60.CrossRefGoogle ScholarPubMed
17.Henning, V, Krogh, E, Movin, M. Out-patient cataract surgery: First experiences from a large hospital department. Act a Ophthalmologica 1985; 63(Suppl.): 76–8.CrossRefGoogle Scholar
18.Dunlop, M. Stress out-patient care minister tells hospitals. Toronto Star: December 3, 1987.Google Scholar
19.Kaufman, J. New developments in hospital funding. In: Proceedings of the conference on new developments in hospital funding, Ontario Hospital Association, Toronto, Ontario May 17, 1989.Google Scholar
20.Drummond, M, Stoddart, G, Torrance, G. Methods for the economic evaluation of health care programmes. Oxford: Oxford University Press, 1987.Google Scholar
21.Eliasoph, H, Hassen, P. Hospital eyes cataract surgery. Health Management Forum 1987; Autumn: 4553.Google ScholarPubMed
22.Goldacre, M, Ingram, R. Changing workload in ophthalmology: Some observations from routine statistics. British Medical Journal 1983; 286: 1560–1.CrossRefGoogle ScholarPubMed
23.Ontario Hospital Association, personal communication, 1986.Google Scholar
24.Ontario Ministry of Health Hospital statistic 1984/85. Toronto: Queen's Printer for Ontario, 1985.Google Scholar
25.Ontario Ministry of Health Hospital statistics 1987/88. Toronto: Queen's Printer for Ontario, 1988.Google Scholar
26.Ingram, R, Banerjee, D, Traynar, M, Thompson, R. Day-case cataract surgery. Transactions of the Ophthalmology Society of the United Kingdom 1980; 100: 205–9.Google ScholarPubMed
27.Ingram, R, Banerjee, D, Traynar, M, Thompson, R. Day-case cataract surgery. British Journal of Ophthalmology 1983; 67: 278–81.CrossRefGoogle ScholarPubMed
28.Donnelly, D. Instilling eyedrops: Difficulties experienced by patients following cataract surgery. Journal of Advanced Nursing 1987; 12: 235–43.CrossRefGoogle ScholarPubMed
29.Smith, S, Drance, S. Difficulties patients have at home after cataract surgery. Canadian Journal of Ophthalmology 1984; 19: 69.Google ScholarPubMed
30.Tinetti, M, Speechley, M, Ginter, S. Risk factors for falls among elderly persons living in the community. New England Journal of Medicine 1988; 319: 1701–7.CrossRefGoogle ScholarPubMed
31.Walters, K. Outcomes of discharge from hospital for elderly people. Journal of Advanced Nursing 1987; 12: 347–55.CrossRefGoogle Scholar
32.Davis, D, Mandel, M. Economics of the shift from inpatient to outpatient eye surgery. Geriatric Ophthalmology 1955; 1: 38–9.Google Scholar
33.Berk, A, Chalmers, T. An analysis of the costs of ambulatory and inpatient care. American Journal of Public Health 1986; 76: 1102–4.CrossRefGoogle Scholar
34.Bloom, B, Krueger, N. Cost and quality effects of outpatient cataract removal. Inquiry 1988; 25: 383–7.Google ScholarPubMed
35.Watts, M, Pearce, J. Day-case surgery. British Journal of Ophthalmology 1988; 72: 897–9.CrossRefGoogle Scholar
36.Williamson, D. Outpatient cataract-implant surgery compared with outpatient cataract standard surgery. Annals of Ophthalmology 1978; 10: 957–65.Google ScholarPubMed
37.Williamson, D. Two hundred consecutive outpatient cataract intraocular lens implant operations. Ophthalmic Surgery 1977; 8: 2934.Google ScholarPubMed
38.Williamson, D. One thousand consecutive outpatient cataract extractions. Ear Nose Throat Monthly 1975; 54: 3749.Google ScholarPubMed
39.Christy, N. The effects of early ambulation on the incidence of postoperative complications of cataract surgery. American Journal of Ophthalmology 1960; 49: 293–7.CrossRefGoogle ScholarPubMed
40.Galin, M, Baras, I, Barasch, K, Boniuk, V. Immediate ambulation and discharge after cataract extraction. Transactions of the American Academy of Ophthalmology and Otholarynology 1974; 78: OP439.Google ScholarPubMed
41.Vernon, S, Cheng, H. Comparison between the complications of cataract surgery following local anaesthesia with short stay and general anaesthesia with a five-day hospitalization. British Journal of Ophthalmology 1985; 69: 360–3.CrossRefGoogle Scholar
42.Hennekens, C, Buring, J. Epidemiology in medicine. Boston: Little, Brown and Company, 1987.Google Scholar
43.Sackett, D, Haynes, R, Tugwell, P. Clinical epidemiology: A basic science for clinical medicine. Boston: Little, Brown and Company, 1985.Google Scholar
44.Sommer, A. Epidemiology and statistics for the ophthalmologist. Oxford: Oxford University Press, 1980.Google Scholar
45.Galin, M, Boniuk, V, Obstbaum, S, Glasser, M. Out-patient cataract surgery. Transactions of the Ophthalmology Society of the United Kingdom 1975; 95: 42–5.Google ScholarPubMed
46.Boyle, M, Torrance, G, Horwood, S, Sinclair, J. A cost analysis of providing neonatal intensive care (NIC) to 500–1499 gram birth weight infants. McMaster University: QSEP Research Report No. 51, 1982.Google Scholar
47.Ontario Ministry of Health Drug benefit formulary. Toronto: Queen's Printer for Ontario, 1984.Google Scholar
48.Statistics Canada. Employment, earnings and hours. Ottawa: Minister of Supplies and Services, 1985.Google Scholar
49.Gilvarry, A, Eustace, P. The medical profile of cataract patients. Transactions of the Ophthalmology Society of the United Kingdom 1982; 102: 502–4.Google ScholarPubMed
50.Evans, R. Strained mercy: Economics of Canadian Health Care. Toronto: Butterworths, 1984.Google Scholar
51.Evans, R, Robinson, G. Surgical day care: Measurement of the economic payoff. Canadian Medical Association Journal 1980; 123: 873–80.Google ScholarPubMed
52.Drummond, M. Economic aspects of cataracts. Consultant's Report for the National Eye Institute, Bethesda, Maryland, 1987.Google Scholar
53.Ferguson, B, Buxton, M, Drummond, M. Measuring and valuing health states relating to visual impairment: A review of literature, concepts and methods. Brunei University: HERG Research Report No. 3, 1988.Google Scholar