Cost-effectiveness of reducing wait times for cataract surgery in Ontario

BACKGROUND: Reducing wait times for cataract surgery is a priority in Ontario. However, no previous analysis has determined whether the extra treatment volumes required to reduce wait times are of good monetary value when compared with allocating those same financial resources to new programs, drugs, or technologies. The objective of the study was to use queuing models to determine the cost-effectiveness of reducing, to target levels, wait times for cataract surgery at the provincial level within 1 to 10 years by increasing treatment volumes. METHODS: A cost-effectiveness analysis was performed by estimating the extra treatment volume required to reduce wait times using queuing model methodology. The cost of these extra treatments was obtained from Ontario provincial data. The incremental benefits of surgery are improvements in quality-adjusted life years (QALYs), and these values were obtained from the clinical literature. Incremental costs were compared with incremental benefits to determine an incremental cost-effectiveness ratio. RESULTS: To reach the publicly stated target wait times, annual treatment volumes must increase by 4%. An extra increase in treatment volumes of 25,660 must also be provided for the transition period from the current wait time. The incremental cost-effectiveness ratio is $17,829 per QALY if the target wait time is achieved in 5 years, and this ratio is less than the common threshold for approval of new interventions, of $50,000 per QALY. INTERPRETATION: Increasing treatment volumes is a cost-effective way of reducing wait times.