A comparative analysis of the cost of cataract surgery abroad and in the United States.

Abstract

Dear Editor, Medical tourism is an exponentially growing industry. Local versus overseas cost considerations for other surgical procedures have led to the evolution this industry with an estimated value of $100 billion a year. The major players are India, South Korea, Thailand, Singapore and Hong Kong, with a combined 1.3 million medical tourists a year. Benefits for these medical tourists include decreased waiting time, comparable technology, minimal language barrier and decreased cost of treatment.[1] As it is well known, cataract is the leading cause of treatable blindness worldwide.[2] 1.82 million cataract procedures were performed in the US in 2010. Given the medical tourism potential for cataract extraction, we decided to perform an economic medical tourism comparison of the cost of unilateral and bilateral traditional cataract extraction with a foldable, acrylic, monofocal to a U.S. patient. We constructed a combined Markov decision model using Tree age Pro (2013 Williamsport, MA) to estimate and compare the cost of cataract surgery to an American domestically and abroad. The following countries were included in our analysis: United States, Mexico, Spain, the United Kingdom, Hungary, Malaysia, Thailand, Germany, India, and Turkey. This model is depicted in Fig. 1. Analyzed costs included travel, consultation, both surgical and anesthesia fees, follow ups, medications, ambulatory surgery center (ASC) fees, intraocular lens (IOL) calculations. Values and probabilities were obtained from published data.[23456] Complications included in the analysis are as follows: Posterior capsular opacification, retinal detachment, retained lens fragment, vitreous loss, endophthalmitis, cystoid macular edema, the need for general anesthesia.Figure 1: Flow diagram for decision analysisThe analyses were separated into unilateral and bilateral surgery. For unilateral surgery, the lowest cost option was the Hungary with a mean of $2,609 with the US being a close second at $2,692. For bilateral surgery, the lowest cost was in Hungary at $3,717. The United States in this case was in the middle at $5243. The rest of the costs in order from lowest to highest cost can be seen for unilateral and bilateral surgery in Tables 1 and 2, respectively.Table 1: Mean costs of unilateral cataract surgery[2 3 4 5 6]Table 2: Mean costs of bilateral cataract surgery[2 3 4 5 6]Linear sensitivity analysis was performed for the costs of lodging/travel and published surgical costs. With travel and lodging costs, the overall ranking of the United States remained the same. Notably, Thailand and Malaysia both improved in the ranking as the relative costs of travel and lodging decreased. When comparing relative surgical costs, there were greater swings in the rankings. United States based cataract surgery has potential to be the most costly as costs of the surgical procedure decreases sufficiently. In Germany and Mexico improve the rankings as the surgical costs decrease. With soaring medical costs, we find that medical tourism is becoming a potential option for American patients with fiscal limitations. We find that unilateral cataract surgery in the United States is a low cost option for a patient living in the United States. Bilateral surgery that is trending more may be a valid and cost-effective option for a patient but personal and professional judgment should be used in each case.