Authors (including presenting author) :
Ng DS(1)(4), Yip BHK(2), Young AL(1)(3), Yip WWK(1)(3), Lam NM(1)(4), Li KK(1)(5), Ko ST(1)(6), Chan WH(7), Aryasit O(8), Sikder S(9), Ferris JD(10), Pang CP(1), Tham CC(1)(3)(4)
Affiliation :
(1)Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, (2)The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, (3)Prince of Wales Hospital, (4)Hong Kong Eye Hospital, (5)United Christian Hospital, (6)Pamela Youde Nethersole Eastern Hospital, (7)Tuen Mun Eye Centre, (8)Prince of Songkla University, (9)Wilmer Eye Institute, Johns Hopkins University, (10)Ophthalmology, Gloucestershire Hospitals
Introduction :
Phacoemulsification cataract extraction surgery is recognized by the WHO as one of the top most cost-effective medical interventions. Nevertheless, the cost of training cataract surgeons is also pertinent to health economic evaluation. Preoperative simulation training aims to shorten phacoemulsification surgery learning curve, which may ultimately reduce the cost of trainees participating in OT. The high cost of implementing technologically advanced, high fidelity medical simulator is a critical factor to consider. The cost-effectiveness of implementing simulation training for cataract surgery is unknown.
Objectives :
To evaluate the cost-effectiveness of preoperative phacoemulsification simulation training in virtual reality simulator and wet laboratory on operating theatre performance.
Methodology :
Trainees were randomized to preoperative intervention by a combination of virtual reality and wet laboratory phacoemulsification with synthetic eyes or wet laboratory phacoemulsification with synthetic eyes only. The external control group consisted of trainees who had wet laboratory basic microsurgical training without phacoemulsification with porcine eyes. All trainees were assessed on video recorded operating theatre performance in 3 sequential cataract patients. The main outcome measures were the International Council of Ophthalmology Surgical Competency Assessment Rubric – phacoemulsification (ICO OSCAR phaco) scores by 2 masked independent graders and the actual cost data for each type of simulation facilities were used to determine the incremental net benefit. The net benefit regression model was constructed for sensitivity analysis with various willingness to pay (WTP) values per ICO OSCAR phaco score.
Result & Outcome :
Trainees who had virtual reality and wet laboratory phacoemulsification achieved higher mean ICO OSCAR phaco scores compared to trainees who only had wet laboratory and control (49.5 +/- standard deviation (SD) 9.8 versus 39.0 +/- SD 15.8 versus 32.5 +/- SD 12.1, P < 0.01). From the perspective of capital cost, if WTP per ICO OSCAR phaco score was above $22500, the combination of virtual reality and wet laboratory phacoemulsification would have higher probability of being cost-effective than wet laboratory phacoemulsification. From the perspective of annual cost (i.e. all simulation facilities were available), wet laboratory phacoemulsification achieved higher probability of cost-effectiveness for WTP per ICO OSCAR phaco score at $1400. However, if WTP threshold was slightly higher at $1850, the combination of virtual reality and wet laboratory phacoemulsification was more cost-effective.
Our economic model demonstrated the thresholds of WTP per unit of surgical skills transfer outcome for different phacoemulsification simulation strategies to be the most cost-effective. Scenario analysis allowed stakeholders to make informed decisions on choosing the simulation training strategy with optimal cost-effectiveness depending on the amount of resource available.
