人工智能在宁夏银川社区糖尿病视网膜病变远程筛查中的应用

目的：评估人工智能(AI)辅助诊断系统在宁夏银川社区糖尿病视网膜病变(DR)筛查中的应用效果。

方法：收集2020-07/2021-07就诊于宁夏银川两个社区卫生服务中心的2型糖尿病患者1 358例2 707眼的眼底彩照,采用Eye Wisdom AI眼病辅助筛查和诊断系统自动检测分析出血、微动脉瘤以及视网膜内微血管异常等DR的特征性改变。根据其国际分期的标准对眼底彩照检测结果进行自动分级,由人工分析组进行图像判读后反馈结果,分析AI辅助筛查系统诊断DR的灵敏度、特异度、误诊率及漏诊率,比较AI与人工分析的一致性,对AI筛查系统与人工分析的结果做Kappa一致性检验。

结果：与人工分析相比,AI诊断有无DR的灵敏度为91.84%,特异度为99.06%,漏诊率为8.16%,误诊率为0.94%,对于二者诊断结果的一致性分析Kappa值为0.817(P<0.001)。与人工分析相比,AI组检测无DR的灵敏度为99.06%,特异度为91.84%; 检测轻度NPDR的灵敏度为85.36%,特异度为98.52%; 中度NPDR的灵敏度为81.53%,特异度为98.55%; 重度NPDR的灵敏度为70%,特异度为99.51%; PDR的灵敏度为86.67%,特异度为99.63%。二者对DR分期诊断一致性分析的Kappa值为0.878(P<0.01)。

结论：AI辅助筛查系统与人工分析的结果一致性好,可以满足DR筛查的需求,为基层社区DR患者提供了一种新的有效防治模式。     

北京农村及城市特定人群原发性开角型青光眼的患病率调查及其筛查方法评价

目的　了解北京地区 4 0岁以上人群原发性开角型青光眼 (POAG)的患病率 ,评价POAG的筛查方法。方法　于 2 0 0 1年 6～ 10月 ,采取逐户上门登记的方法 ,对北京市区北部 5个社区和北京郊区南端 3个自然村的 4 0岁以上人群进行眼病流行病学调查。青光眼筛查的现场检查项目包括矫正视力、验光、倍频视野计检测、非接触眼压计测定、VanHerick法评估周边前房深度、眼底照相。凡可疑青光眼及青光眼患者均进行青光眼标准检查 ,包括复查眼压、前房角镜检查、Octopus自动视野计的阈值视野检查、眼底立体照相。结果　农村及城市实查人数分别为 1980人和 2 4 71人 ,共计 4 4 5 1人 ,应答率分别为 79 5 8%和 87 13%。男性人群中农村及城市POAG的患病率分别为 1 97%和 2 0 7% ,女性人群中农村及城市POAG的患病率分别为 1 0 4 %和 1 4 2 %。POAG的患病率随年龄增长呈上升趋势 ,上升曲线呈指数变化。诊断的青光眼患者中 ,约 5 0 %初次测定眼压 <2 1mmHg (1mmHg =0 133kPa)。本调查中新发现的POAG在农村和城市分别占 92 30 %和 87 30 % ;POAG单眼致盲率在农村和城市分别为 15 4 0 %和 10 90 %。结论　采用眼底照相对视神经和视网膜神经纤维层进行综合评价的方法 ,所检出的青光眼患病率高于国内以往的研究结果 ,与亚     

糖尿病视网膜病变的数码眼底照相筛查方法评价

目的 评估单视野和多个视野数码彩色眼底照相方法筛查早期糖尿病视网膜病变(DR)的价值.设计 前瞻性临床病例系列.研究对象 连续选择北京同仁医院糖尿病科门诊确诊的非增殖性糖尿病视网膜病变的糖尿病患者108例.方法所有病例均充分散瞳,分别进行单视野、双视野和6视野数码彩色眼底照相和荧光素眼底血管造影(FFA)检查.眼底病专科医师阅片进行诊断,以FFA诊断为标准.主要指标 各种视野眼底照相方法进行筛查诊断的敏感性、特异性及与FFA诊断结果的一致性.结果 以DRI期为筛查阈值时,单视野眼底彩色照相的敏感度、特异度、Kappa值分别为73.21%、88.64%、0.46;双视野眼底照相分别为75.00%、86.36%、0.47;6视野眼底照相分别为76.05%、87.80%、0.48.以DR2期为筛查阈值时,单视野眼底彩色照相的敏感度、特异度、Kappa值分别为72.46%、93.01%、0.68;双视野眼底照相分别为73.91%、93.01%、0.69;6视野眼底照相分别为75.36%、92.81%、0.70.单视野与6视野眼底照相诊断结果一致性Kappa值为0.97.结论 黄斑为中心单视野45°眼底照相可作为早期尤其是DR2期以上糖尿病视网膜病变的筛查方法.     

糖尿病视网膜病变人工智能自动诊断系统在社区和医院老年糖尿病患者中的应用效果分析

目的比较基于彩色眼底像阅片的人工智能(AI)系统分别在社区和医院筛查和(或)诊断糖尿病视网膜病变(DR)的效率和差异, 初步评价其应用价值。方法回顾性和前瞻性相结合研究。回顾性收集2018年7月至2021年3月于河南省眼科研究所连续就诊的老年糖尿病患者1 608例的临床资料。其中, 男性659例, 女性949例;年龄中位数64岁。前瞻性收集2018年12月至2019年4月以社区为来源主动招募的老年糖尿病患者496例的临床资料。其中, 男性202例, 女性294例;年龄中位数62岁。由眼科或经培训的内分泌科医生对患者行双眼免散瞳眼底彩色照相检查, 拍摄以黄斑中心凹为中心后极部45°正位片。AI系统基于深度学习YOLO源码开发, 采用"AI+人工复核"方式最终确定DR诊断并分为0～ 4期, 其中1期为无需转诊DR, 2～ 4期为需转诊DR。结果 AI总读片1 989例(94.5%, 1 989/2 104 ), 其中社区、医院来源患者分别为437 (88.1%, 437/496)、1 552 (96.5%, 1 552/1 608)例。社区来源AI读片率低于医院来源, 差异有统计学意义(χ...     

新技术在糖尿病视网膜病变筛查中应用的研究进展

由于全球2型糖尿病患病率逐年上升，糖尿病视网膜病变(DR)导致的失明和视力受损患病率也随之升高。DR筛查计划对临床前期及已确诊患者的诊疗至关重要，其中，筛查周期、成本效益、地区资源配置等均为筛查计划需要考虑的因素。超广角眼底照相设备、手持移动照相装置、基于人工智能的远程眼科诊疗系统等新技术使筛查策略与成本效益得到优化，本文将对其应用展开综述。此外，新的证据表明，视网膜检查能够早期识别有心血管疾病或认知障碍性疾病的个体，而DR筛查的价值将不局限于预防视力损害。     

单视野免散瞳数码眼底照相筛查糖尿病视网膜病变的敏感性和特异性

目的:单视野免散瞳眼底照相和散瞳直接眼底镜检查与荧光素眼底血管造影(fundus fluorescein angiography,FFA)相比较,评价其筛查糖尿病视网膜病变(diabetic retinopathy,DR)的敏感性和特异性。方法:1型或2型糖尿病患者93例186眼,先后进行单视野免散瞳数码眼底照相、散瞳直接眼底镜检查和FFA,以FFA诊断结果作为比较标准,评价单视野免散瞳数码眼底照相和散瞳直接眼底镜筛查DR的敏感性和特异性。结果:单视野免散瞳数码眼底照相检出DR的敏感性和特异性分别为80.4%和94.7%,而散瞳直接眼底镜检出DR的敏感性和特异性分别为64.2%和84.2%。当把筛查阈值下调至中度非增殖性DR(M-NPDR)后,单视野免散瞳数码眼底照相检出DR的敏感性和特异性分别提高为88.9%和98.4%,散瞳直接眼底镜检出DR的敏感性和特异性也均有提高,分别为71.5%和96.7%。结论:单视野免散瞳数码眼底照相是筛查DR的有效工具。     

基于眼底照相的原发性开角型青光眼人群筛查成本-效果分析

目的 基于“北京眼病研究”与“邯郸眼病研究”获得的基础数据,对采用眼底照相在人群开展原发性开角型青光眼（POAG）筛查的成本-效果进行评价,为POAG人群筛查策略的制定提供数据支持。设计 成本-效果分析。研究对象 “北京眼病研究”及“邯郸眼病研究”中关于POAG流行病学调查结果。方法 采用R软件计算40岁以上POAG在人群筛查和医院机会就诊两种诊疗模式下的伤残调整生命年,并基于2014年的成本,计算两种诊疗模式的直接成本费用（筛查成本、诊断成本、干预成本）,然后比较两种模式的成本-效果。主要指标 成本费用,伤残调整生命年。结果 以1万例40岁以上社区人口为拟合基数,分析结果提示：如果每5年筛查一次,可及早发现POAG患者并及时药物控制,其视功能损害率为30%左右;而医院就诊方式,其视功能损害率均在50%以上;采用眼底照相完成POAG的筛查、确诊及治疗所需直接医疗成本为175万;通过医院机会就诊模式,需直接成本为406万,但开展社区筛查发生的疾病负担,即伤残调整生命年（1.33）却低于医院机会就诊模式（2.76）。结论 POAG的社区筛查可降低由于其导致的伤残调整生命年,对患者视功能的维持及改善生命质量具有重要意义,且可降低直接医疗成本。     

青光眼筛查的意义及方法评价

青光眼患病率随着人口的增长及老龄化而增加，它对人类生存质量、社会经济的挑战是巨大的。青光眼筛查符合WHO推荐的疾病筛查标准的大多数条件。筛查进而早期诊断青光眼提供了避免青光眼盲的最佳机会，早期治疗预后最佳。非散瞳眼底数码照像以及倍频视野检查对开角型青光眼筛查价值较大。考虑到成本-效益，青光眼筛查应在高危人群如50岁以上老年人、糖尿病、高度近视中进行。     

糖尿病视网膜病变人工智能自动诊断系统在社区和医院老年糖尿病患者中的应用效果分析

目的:比较基于彩色眼底像阅片的人工智能（AI）系统分别在社区和医院筛查和（或）诊断糖尿病视网膜病变（DR）的效率和差异,初步评价其应用价值。方法:回顾性和前瞻性相结合研究。回顾性收集2018年7月至2021年3月于河南省眼科研究所连续就诊的老年糖尿病患者1 608例的临床资料。其中,男性659例,女性949例;年龄中位...     

免散瞳和散瞳眼底数码照相在眼底病筛查中的优势分析

目的：与金标准荧光造影比较,评估免散瞳眼底照相及散瞳眼底照相作为眼底筛查诊断方法的优势。

方法：选取上海市浦东新区4个街道纳入糖尿病慢性病管理档案的患者276例,进行糖尿病视网膜病变(DR)的筛查。在进行视力、裂隙灯检查、屈光检查之后,对所有参检人员分别进行双眼免散瞳眼底数码照相、双眼散瞳眼底数码照相及眼底荧光造影; 由专业人员集中阅片并给出检查报告。可疑眼底病患者,预约相应的专科完成进一步诊治。

结果：共计276例接受眼底病筛查,双眼分别进行免散瞳及散瞳眼底数码照相,共得到1 104张彩色眼底图片,其中1 056张(95.65%)眼底像可用于分析。免散瞳眼底数码照相获得的眼底图片中,可以评估的眼底图片408张,基本可以评估的眼底图片116张,不能评估的眼底图片28张; 散瞳眼底数码照相获得的眼底图片中,可以评估的眼底图片432张,基本可以评估的眼底图片100张,不能评估的眼底图片20张。经卡方检验,两种方式获得的眼底图片质量差异无统计学意义(P>0.05)。与眼底荧光造影(FFA)相对比,以DR Ⅰ期作为临界值,免散瞳眼底数码照相的诊断特异性是95.71%,诊断敏感性是93.56%; 散瞳眼底数码照相的诊断特异性是95.43%,诊断敏感性是98.02%; 两种筛查方法比较差异无统计学意义(P>0.05); 以DR Ⅱ期作为临界值,免散瞳眼底照相对DR的诊断特异性和敏感性分别为95.35%和93.44%; 散瞳眼底照相对DR的诊断特异性和敏感性分别为95.81%和98.36%; 两种筛查方法比较差异无统计学意义(P>0.05)。

结论：免散瞳眼底数码照相与散瞳眼底数码照相均可用于眼底病筛查诊断。免散瞳眼底数码照相更加简易、快捷,适合大规模筛查时使用。散瞳眼底照相对于疾病的跟踪随访更能提供详细的参考信息。     

Screening for refractive error and fitting with spectacles in rural and urban India: Cost-effectiveness

Objectives:?To assess the cost-effectiveness of screening for refractive error and fitting with glasses in India.

Methods:?We populated a decision tree with the costs of screening and spectacles, prevalence of varying levels of presenting and best corrected visual acuity (BCVA) from two studies, and sensitivity and specificity of screening. We calculated dollars spent per disability adjusted life year (DALY) averted separately in urban and rural areas for school-based screening (SBS) and primary eye care (PEC) programs that fit spectacles to individuals presenting for care. We conducted a series of univariate and probabilistic sensitivity analyses. An intervention was inferred to be highly cost-effective if the incremental cost-effectiveness ratio (ICER) was less than the gross domestic product (GDP) per capita and moderately cost-effective if the ICER was less than three times this level.

Results:?Compared with no screening, urban SBS was highly cost-effective; rural SBS was moderately cost-effective for ages 5–15 and highly cost-effective for ages 7–15. Both urban and rural PEC were moderately cost-effective in comparison to SBS. Probabilistic sensitivity analysis suggested that SBS is likely the most cost-effective solution for refractive error in India if the 5–15 year old age group is targeted; primary eye care is the best choice if a high value is placed on DALYs and the 7–15 year old age group is targeted.

Conclusion:?Both SBS and PEC Interventions for refractive error can be considered cost-effective in India. Which is the more cost-effective depends on the choice of targeted age group and area of the intervention.     

Cost-utility Analysis of Screening for Diabetic Retinopathy in Japan: A Probabilistic Markov Modeling Study

ABSTRACT

Purpose: To evaluate the cost-effectiveness for a screening interval longer than 1 year detecting diabetic retinopathy (DR) through the estimation of incremental costs per quality-adjusted life year (QALY) based on the best available clinical data in Japan.

Methods: A Markov model with a probabilistic cohort analysis was framed to calculate incremental costs per QALY gained by implementing a screening program detecting DR in Japan. A 1-year cycle length and population size of 50,000 with a 50-year time horizon (age 40–90 years) was used. Best available clinical data from publications and national surveillance data was used, and a model was designed including current diagnosis and management of DR with corresponding visual outcomes. One-way and probabilistic sensitivity analyses were performed considering uncertainties in the parameters.

Results: In the base-case analysis, the strategy with a screening program resulted in an incremental cost of 5,147 Japanese yen (¥; US$64.6) and incremental effectiveness of 0.0054 QALYs per person screened. The incremental cost-effectiveness ratio was ¥944,981 (US$11,857) per QALY. The simulation suggested that screening would result in a significant reduction in blindness in people aged 40 years or over (?16%). Sensitivity analyses suggested that in order to achieve both reductions in blindness and cost-effectiveness in Japan, the screening program should screen those aged 53–84 years, at intervals of 3 years or less.

Conclusions: An eye screening program in Japan would be cost-effective in detecting DR and preventing blindness from DR, even allowing for the uncertainties in estimates of costs, utility, and current management of DR.     

Prevalence and risk factors of dry eye disease in young and middle-aged office employee:a Xi’an Study

AIM:To estimate the prevalence of and risk factors for dry eye disease(DED)in young and middle-aged office employee in Xi’an.METHODS:This cross-sectional study of the prevalence of and risk factors for DED investigated 486 young and middle-aged Chinese office employee in Xi’an.DED symptoms and potential risk factors were assessed using the ocular surface disease index combined with a risk factors questionnaire,and tear function was evaluated using the tear film break-up time and Schirmer’s test.Possible risk factors for DED were estimated by binary Logistic regression analysis.RESULTS:DED was diagnosed in 100 females and 96 males,giving a prevalence of 40.3%[95%confidence interval(CI)=36.0%-44.7%].The multivariate binary Logistic regression model indicated that the possible risk factors for DED were being female(OR=1.592,95%CI=1.034-2.451,P=0.035),being aged≥40 y(OR=1.593,95%CI=1.034-2.454,P=0.035),using a VDT daily for>6 h(OR=1.990,95%CI=1.334-2.971,P=0.001),the presence of central air conditioning(OR=1.548,95%CI=1.053-2.276,P=0.026),and self-reported dryness of the mouth and nose(OR=1.589,95%CI=1.071-2.357,P=0.021).CONCLUSION:There is a high prevalence of clinically diagnosed DED in young and middle-aged video displayterminal(VDT)users.Interventions against the modifiable risk factors should be taken to prevent the occurrence and development of DED in this population.     

Cost-effectiveness of Descemet stripping automated endothelial keratoplasty versus penetrating keratoplasty in patients with endothelial dysfunction in India

Purpose:The aim of this study was to compare the cost-effectiveness and perform cost-utility analysis of Descemet stripping automated endothelial keratoplasty (DSAEK) vs. penetrating keratoplasty (PK) in Indian population.Methods:This was an institutional, ambispective, observational study. Patients who underwent PK or DSAEK for endothelial dysfunction were included and followed up for 2 years; those with other ocular comorbidities were excluded. The analysis was performed from the patient’s perspective receiving subsidized treatment at a tertiary care hospital. Detailed history, ophthalmic examination, total expenditure by patient, and clinical outcomes were recorded. The main outcome measures were best spectacle-corrected visual acuity (BSCVA), graft survival (Kaplan–Meier survival estimates), incremental cost-effectiveness ratio (ICER), and incremental cost-utility ratio (ICUR). Utility values were based on quality-adjusted life years (QALYs) associated with visual acuity outcomes. Statistical analysis was performed using SPSS software package, version 12.1; a value of P < 0.05 was considered statistically significant.Results:A total of 120 patients (PK: 60, DSAEK: 60) were included. At 2 years, for a similar logMAR BSCVA, [PK (0.32 ± 0.02), DSAEK (0.25 ± 0.02); P = 0.078], the overall cost for PK (13511.1 ± 803.3 INR) was significantly more than DSAEK (11092.9 ± 492.1 INR) (difference = 1952.6 INR; P = 0.01). ICER of DSAEK relative to PK was –39,052 INR for improvement in 1 logMAR unit BSCVA. ICUR of DSAEK relative to PK was –1,95,260 INR for improvement in 1 QALY.Conclusion:DSAEK was more cost-effective than PK in patients with endothelial dysfunction at 2 years.     

Retinal Photography Screening Programs to Prevent Vision Loss from Diabetic Retinopathy in Rural and Urban Australia: A Review

ABSTRACT

Purpose: This review assessed the effectiveness of diabetic retinopathy (DR) screening programs, using retinal photography in Australian urban and rural settings, and considered implications for public health strategy and policy.

Methods: An electronic search of MEDLINE, PubMed, and Embase for studies published between 1 January 1996 and the 30 June 2013 was undertaken. Key search terms were “diabetic retinopathy,” “screening,” “retinal photography” and “Australia.”

Results: Twelve peer-reviewed publications were identified. The 14 DR screening programs identified from the 12 publications were successfully undertaken in urban, rural and remote communities across Australia. Locations included a pathology collection center, and Indigenous primary health care and Aboriginal community controlled organizations. Each intervention using retinal photography was highly effective at increasing the number of people who underwent screening for DR. The review identified that prior to commencement of the screening programs a median of 48% (range 16–85%) of those screened had not undergone a retinal examination within the recommended time frame (every year for Indigenous people and every 2 years for non-Indigenous people in Australia). A median of 16% (range 0–45%) of study participants had evidence of DR.

Conclusions: This review has shown there have been many pilot and demonstration projects in rural and urban Australia that confirm the effectiveness of retinal photography-based screening for DR.     

Training of nonophthalmologists in diabetic retinopathy screening

The burden of diabetes mellitus (DM) and diabetic retinopathy (DR) is at alarming proportions in India and around the globe. The number of people with DM in India is estimated to increase to over 134 million by 2045. Screening and early identification of sight-threatening DR are proven ways of reducing DR-related blindness. An ideal DR screening model should include personalized awareness, targeted screening, integrated follow-up reminders, and capacity building. The DR screening technology is slowly shifting from direct examination by an ophthalmologist to remote screening using retinal photographs, including telescreening and automated grading of retinal images using artificial intelligence. The ophthalmologist-to-patient ratio is poor in India, and there is an urban–rural divide. The possibility of screening all people with diabetes by ophthalmologists alone is a remote possibility. It is prudent to use the available nonophthalmologist workforce for DR screening in tandem with the technological advances. Capacity-building efforts are based on the principle of task sharing, which allows for the training of a variety of nonophthalmologists in DR screening techniques and technology. The nonophthalmologist human resources for health include physicians, optometrists, allied ophthalmic personnel, nurses, and pharmacists, among others. A concurrent augmentation of health infrastructure, conducive health policy, improved advocacy, and increased people''s participation are necessary requirements for successful DR screening. This perspective looks at the characteristics of various nonophthalmologist DR screening models and their applicability in addressing DR-related blindness in India.     

Cost-effectiveness of screening for amblyopia

BACKGROUND: The effectiveness of a screening program for amblyopia has been discussed controversely for several years. While the medical profit is obvious, little is known on the cost-effectiveness of such a screening program. METHODS: By literature research all important variables were determined: incidence of amblyopia, sensitivity of different screening modalities, effectiveness of therapy, costs as well as the loss of utility and life quality by an existing amblyopia. Based on those data in a simple model the costs of a screening program for amblyopia were determined per quality adjusted life year (QALY). The result was analyzed for its stability by sensitivity analysis and compared to the costs of other therapies. RESULTS: Amblyopia occurs with an incidence of approximately 2 % (1.3 - 12 %). Most Screening programs reach a sensitivity of 60 - 90 % and cause costs of 900 - 1400 Euro per detected case. By appropriate therapy with mean costs of 2300 Euro approx. 60 % of the cases obtain useful vision of > 20/40. However, therapy results vary considerably. After discounting the incremental cost-effectiveness ratio (ICER) reaches 7684 Euro/QALY for a screening and treatment program for amblyopia. This is well comparable with other therapies and accepted to be cost-efficient. Sensitivity analysis yielded 24 700 Euro/QALY and 57,633 Euro/QAL with higher discounting for worst case scenarios. CONCLUSION: Screening for amblyopia meets the basic requirements of cost-effectiveness.     

Glaucoma screening. A cost-effectiveness analysis

We designed an intricate model of the process of glaucoma screening, diagnosis, and treatment in order to evaluate the medical care costs of such efforts in relation to the benefits in terms of quality-adjusted years of vision saved, utilizing the economic principles of cost-effectiveness analysis. Although a relatively limited data base and numerous assumptions concerning the accuracy of diagnostic tests, the natural history of ocular hypertension and glaucoma, and the effectiveness of available treatment modalities, limit our ability to draw definitive conclusions concerning the cost-effectiveness of various glaucoma screening options, our analysis indicates that glaucoma screening is probably cost-effective when targeted at certain subgroups of the population. Our analysis suggests that changes in several aspects of existing screening policies may be appropriate if cost-effectiveness is to be used as one of the criteria for the efficient allocation of resources to and within screening programs. Specifically, combinations of screening tests and screening targeted at high risk populations such as blacks, diabetics, and relatives of glaucoma patients are probably more cost-effective than screening of the general population with a single test. In younger populations, the importance of detecting ocular hypertension argues for the use of tonometry. Ophthalmoscopy may be more cost-effective in older age groups in whom the higher prevalence of glaucoma outweighs the need for identifying ocular hypertensives. In the very elderly, automated perimetry becomes cost-effective since the detection of established field loss will have greater yield. In addition, it is evident that diversion of resources away from actual screening efforts and towards efforts aimed at improving follow-up and compliance would be an additional cost-effective strategy.     

Cost-utility analysis of cataract surgery in Japan: a probabilistic Markov modeling study

Objective

To evaluate with the best available clinical data in Japan the cost-effectiveness of cataract surgery through the estimation of the incremental costs per quality-adjusted life years (QALYs) gained.

Methods

A Markov model with a probabilistic cohort analysis was constructed to calculate the incremental costs per QALY gained by cataract surgery in Japan. A 1-year cycle length and a 20-year horizon were applied. Best available evidence in Japan supplied the model with data on the course of cataract surgery. Uncertainty was explored using univariate and probabilistic sensitivity analysis.

Results

In base case analysis, cataract surgery was associated with incremental costs of Japanese yen (¥) 551,513 (US$ 6,920) and incremental effectiveness of 3.38 QALYs per one cataract patient. The incremental cost effectiveness ratio (ICER) was ¥ 163,331 (US$ 2,049) per QALY. In Monte Carlo simulation, the average patient with cataract surgery accrued 4.65 [95 % confidence interval (CI): 2.75–5.69] more QALYs than patients without surgery, giving an ICER of ¥ 118,460 (95 % CI: 73,516–207,926) (US$ 1,486) per QALY.

Conclusions

Cataract surgery in Japan is highly cost-effective even when allowing for the uncertainty of the known variability that exists in estimates of the costs, utilities, and postoperative complication rate.