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Cost effect of surgeon and patient discretion in regard to cataract surgery

机译：外科医生在白内障手术方面的成本影响和患者的酌处权

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Purpose: The purpose of this study is to examine the cost effect of surgeon and patient discretion in regard to cataract surgery and how this affects population health care costs. Methods: A model of cataract progression was created from preexisting published data and combined with mortality data and Medicare cataract statistics to estimate the effect of mortality on decreasing the rate of cataract surgery if surgery was delayed until any cataract progression occurred. Results: Five-year cataract progression rates were determined for a given patient age, sex, and type of cataract. Combined with 5-year death rates, delaying surgery until progression occurred resulted in a 1.1% decrease in surgery for nuclear sclerosis at age 45 that increased to a 33.8% decrease by age 90; a 1.5% decrease in surgery for cortical cataract at age 45 that increased to a 51.1% decrease by age 90; and a 1.6% decrease in surgery for posterior subcapsular at age 45 that increased to a 59.7% decrease by age 90. The effect of this decrease in surgical volume on Medicare was estimated to result in a 13% overall decrease in cataract surgery annually at a cost of ~$660 million dollars per year. Conclusion: Overall, we conclude that surgeon and patient discretion in regard to cataract surgery has a substantial cost effect with the potential to reduce surgical volume by as much as 13% by the decision to delay surgery as a result of patient mortality.
机译：目的：本研究的目的是检查外科医生在白内障手术方面的成本效果和患者的判断力，以及这如何影响人群医疗保健成本。方法：根据已存在的已发表数据创建白内障进展模型，并与死亡率数据和Medicare白内障统计数据相结合，以评估如果推迟手术直至发生任何白内障进展，死亡率对降低白内障手术率的影响。结果：确定了给定患者年龄，性别和白内障类型的五年白内障进展率。结合5年死亡率，将手术推迟到进展为止，导致45岁时的核硬化手术减少了1.1％，到90岁时增加了33.8％。 45岁时皮质白内障手术减少1.5％，到90岁时减少51.1％;而45岁时后囊下手术减少了1.6％，到90岁时减少了59.7％。这种手术量减少对Medicare的影响，估计每年在白内障手术中白内障手术总体减少13％。每年约需6.6亿美元。结论：总的来说，我们得出结论，外科医生和患者对白内障手术的谨慎态度具有实质性的成本效应，并且由于患者死亡而决定推迟手术，因此有可能将手术量减少多达13％。

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