Government investment in public cataract services should be a health policy priority, according to a report commissioned by Vision 2020.
Conducted by the University of New South Wales (UNSW), the report found that reducing wait lists for cataract surgery would deliver savings to the health system, societies and individuals, while also increasing patient quality of life years (QALY).
The report estimated that 243,139 Australians are currently living with visually significant cataract
The UNSW researchers analysed available data to determine the (pre-COVID) unmet need for public cataract surgery and the additional costs associated with these waits.
The report estimated that 243,139 Australians are currently living with visually significant cataract (visual acuity worse than 6/12), including 10,616 Aboriginal and Torres Strait Islander people and 232,523 non-Indigenous Australians. This number is expected to increase to 308,516 by 2030 due to our aging population.
Currently, about 29% of cataract surgeries for non-Indigenous Australians and 80% of cataract surgeries for Aboriginal and Torres Strait Islander people are performed in the public hospital system. Median waiting times, from referral to admission for surgery, range from three to 18 months, with a small number of patients waiting more than two years for cataract surgery.
While the wait time for cataract surgery in the private setting is significantly shorter, the associated out-of-pocket costs, which can be AU$2,500 on average for those without private insurance, are a deterrent. Out-of-pockets for patients with private health insurance vary depending on the level of insurance.
Costs of Waiting
The report calculated significant costs to the health system associated with wait periods, due to falls and vehicle accidents caused by cataract-impaired vision. Additionally, it stated that impaired vision due to cataract impacts individuals and society with reduced quality of life due to poor vision; depressive symptoms; failing to meet the vision standard for a driver’s licence (31% or >13,000 drivers); driving cessation (25%); and property damage associated with increased crash risk while waiting for cataract surgery.
Noting discrepancies in reporting and triaging of cataract patients across Australia’s states and territories, the authors recommended that avoidable vision impairment and the negative health consequences associated with cataract could be reduced with investment in:
- Streamlined pathways to access cataract surgery, including standardised referral and triage processes to ensure referrals are appropriately targeted,
- Higher volume cataract surgery services for public patients in public (or private) hospitals to meet demand and reduce waiting time for surgery,
- Financial incentives to promote high quality outcomes and efficiency in public hospital services while maintaining eye surgery training programs for ophthalmology trainees, and
- Increased provision of surgical services linked to outreach and regional cataract assessment services to address current inequity in access and longer wait time for public cataract services for Aboriginal and Torres Strait Islander peoples.
Significant Savings in Expediting Surgery
In 2018-19, there were over 245,000 admissions for cataract surgery, of which 72,270 admissions were in public hospitals.
Restrictions on elective surgeries due to COVID-19 significantly impacted cataract services in 2020, and in April 2021 we saw elective surgeries halted, adding further pressure to the system.
The report estimated that an additional 74,150 surgeries would be required to expedite surgery for public patients who were waiting for an initial ophthalmological assessment or surgical admission in the 2019-20 financial year alone. Of these, at least 8,500 were needed to address surgery waiting lists for Aboriginal and Torres Strait Islander peoples.
At a total cost of $4,104 per eye in 2019-2020, including one pre-operative assessment, the surgery and two post-operative reviews, these additional surgeries would cost the health system AU$304.3M.
However, the report highlighted that expediting cataract surgery delivers direct savings to the health system by reducing the number of falls and vehicle accidents that require medical care.
If the waiting time for cataract surgery (from referral to surgery admission) were reduced to one month for each eye (compared to three-, six- and 12-month waiting periods), it estimated that the reduced number of falls and vehicle accidents would save the health system $4.71M, $11.77M and $10.63M respectively. The greatest reduction in falls (hence savings) come following surgery on a patient’s first eye.
The report highlights the strong evidence in favour of cataract surgery compared to no intervention. While, the number of QALYs gained following initial cataract surgery slightly exceeded that with second eye surgery, it states that both procedures are considered cost-effective. Indeed analysis of cost-effectiveness in the United States estimated that cataract surgery delivered a 4,567% financial return on investment to society over 13 years.