The Use of Clinical Evidence in Commissioning Adult Strabismus Surgery
by Catherine Billington
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Purpose/Problem
Adult squint surgery for patients without binocular vision is considered low priority for funding. In January 2018 Gloucestershire Hospitals NHSF Trust reviewed the funding of adult cosmetic squint surgery. Using several sources of clinical evidence we were able to persuade the commissioning group to continue routine funding of this important treatment
Method
The Adult Strabismus Quality of Life Questionnaire (AS-20) is routinely used in the assessment of adults having squint surgery. Pre and post-operative scores for the 3 years prior to 2018 were presented to the commissioning group along with Royal College of Ophthalmology guidance and data obtained from Medisoft EPR detailing our own department’s throughput of patients. This provided a robust argument for the cost-effectiveness of this type of surgery in context with other procedures.
Results
The AS-20 scores showed an improvement following surgery with the average increasing from 43.45 out of 100 to 80.03. The psychosocial subscale showed the biggest improvement. 105 squint operations were performed on non-binocular patients over 5 years. Treating 21 patients per year equates to the cost of treating 2 anti-VEGF patients for the same period.
Conclusion
Due to financial pressures procedures seen to be “cosmetic” are at risk of being decommissioned. By documenting quality of life information as well as electronically recording clinical improvements following strabismus surgery the clinician has robust clinical evidence instantly available to present to commissioners, which can be used to inform policy making.