Thursday, 4 July 2019
Eliminating waiting times for cataract surgery would be a cost-effective health system intervention, largely driven by the falls prevention benefits related to improved vision, a just-published New Zealand study has found.
A group of researchers from the University of Otago, research company Adapt Research Ltd and Tairawhiti District Health Board, found that expediting cataract surgery not only improves older people’s vision, but also prevents harm from falls.
Professor Nick Wilson from the University of Otago, Wellington, says cataracts are the most common worldwide cause of poor vision and it is well established that people with cataracts have more falls. These falls can lead to hospitalisation and even premature death.
The researchers performed a modelling study examining what would happen if DHBs cleared cataract waiting lists, reducing harm from falls by paying private providers to eliminate waiting lists for cataract surgery. They did this by modelling the costs and benefits of expedited surgery with detailed New Zealand injury and health system cost data.
Study lead author Dr Matt Boyd from Adapt Research says expediting cataract surgery by 12 months as a falls prevention strategy appears to be very cost-effective, with good health outcomes for comparatively little investment by District Health Boards.
“Having cataracts makes someone twice as likely to fall. But currently patients in New Zealand can wait over 300 days for cataract surgery,” Dr Boyd says.
“Our findings provide modelling evidence that expediting cataract surgery is more cost-effective than many other health interventions, giving some of the best outcomes per dollar for limited healthcare funds.
“Our study suggests that DHBs should try to expedite cataract surgery, particularly in younger patients. They should perform – or contract out – more cataract operations and operate on people with mild cataracts.”
Study co-author Dr Graham Wilson, an honorary senior lecturer at the University of Otago and ophthalmologist at Tairawhiti DHB, says falls that cause injuries in older people are a serious problem.
“One third of people over 65 fall at least once a year and one in twenty will have a fracture or require hospitalisation.”
The New Zealand Health Quality and Safety Commission recommends assessment of vision and treatment of any visual disorder as part of a comprehensive falls prevention plan. It recommends falls prevention should include strength and balance exercises and home safety modifications.
Professor Wilson says previous University of Otago studies using the same falls prevention model as the one used in the cataracts’ study have shown such exercise programmes and home safety programmes are also good value for money interventions for the New Zealand health sector.
Funding support for the study, which was published in medical journal Injury Prevention and for developing the falls prevention model came from the Rapanui Trust, Gisborne; the New Zealand Health Research Council and the Ministry of Business, Innovation and Employment.
Request a copy of the research paper:
A copy of the just-published research Cataract surgery for falls prevention and improving vision: modelling the health gain, health system costs and cost-effectiveness in a high-income country is available on request.
For further information, contact:
Dr Matt Boyd
Adapt Research Ltd
Dr Graham Wilson
Honorary Senior Lecturer, University of Otago
Ophthalmologist, Tairawhiti District Health Board