Comparison of Cost-Utility, Visual Acuity, and Humanistic Outcomes of Cataract Surgery Performed in the United States Versus International Outreach Campaigns

Abstract

Background: This study compares the cost-utility, visual acuity, and humanistic outcomes of phacoemulsification surgery performed during international outreach campaigns to outcomes in the U.S. Objective: Humanitarian organizations frequently perform cataract surgeries in underserved regions, yet the outcomes of phacoemulsification in these settings remain unexplored. This study aims to compare the visual acuity outcomes, quality-of-life outcomes, and cost of phacoemulsification surgery during international outreach campaigns with those in the U.S. Methods: This retrospective review analyzed 344 cases from Women for World Health (W4WH) missions and 305 consecutive cases from the academic practice of the lead surgeon of W4WH in the US. The pre-operative (pre-op) visual acuity, post-operative (post-op) visual acuity at day 1, and best-corrected visual acuity (BCVA) at post-op month 1 were compared to baseline. The change in visual acuity was compared between the two groups. Complication rates, cost per case, and quality-of-life measures were evaluated for the mission group compared to cataract surgery outcomes in the developed world. Results: The mission cohort had worse baseline visual acuity than the U.S. cohort (1.36 logMAR vs. 0.50 logMAR, p < 0.0001) and showed greater mean improvement (1.24 logMAR vs. 0.35 logMAR, p < 0.0001). Both cohorts achieved similar BCVA at post-op month 1 (0.13 logMAR). The cost for the mission group was USD 276 per surgery. A total of 93.94% of patients in the mission group achieved a BCVA of 20/40 or better, which is comparable to the U.S. outcomes. Conclusions: The dramatic impact, immediacy, and enduring effect of cataract surgery using phacoemusification on quality of life, mental health, and economic return on investment make it the ideal procedure for humanitarian settings. Considering all of the available metrics, our data support the continued expansion of humanitarian efforts by cataract surgery organizations worldwide.