Comparing the long-term impact on health care resources utilization and costs due to various single-piece acrylic monofocal intraocular lens implantation during cataract surgery: a cost-consequence analysis for the United Kingdom, Italy, and Denmark

Abstract

PurposeThe objective of this study was to estimate the cost impact of neodymium-doped yttrium aluminum garnet (Nd:YAG) laser capsulotomy and its complications due to single-piece acrylic monofocal intraocular lenses (IOLs) in the healthcare setting of United Kingdom, Italy, and Denmark.Materials and methodsA hypothetical cost-consequence model was developed to estimate economic burden of Nd:YAG laser capsulotomy due to different single-piece acrylic monofocal IOLs. Cumulative incidence of Nd:YAG laser capsulotomy at 3 years after cataract surgery with five single-piece monofocal acrylic IOLs was sourced from retrospective data analysis of electronic medical records of cataract patients in the United Kingdom. Risk probability of post-Nd:YAG laser complications, ie, retinal detachment, glaucoma, and cystoid macular edema at 3 years was derived using published literature. Unit costs were taken from publicly available sources with all costs converted to euro (€). Number of cataract procedures per year for each country was sourced from Eurostat statistics.ResultsFor the estimated cataract procedures carried out nationally every year, single-piece monofocal hydrophobic AcrySof IOL was associated with substantially lower cases of Nd:YAG laser capsulotomy procedures and subsequent complications in 3 years after cataract surgery when compared to other single-piece monofocal acrylic IOLs. The total cost savings with the use of AcrySof over other IOLs in countries assessed ranged from €0.5 to €4.7 million (vs AMO Tecnis) and €2.1 to €17.9 million (vs Rayner C-/Super-flex).ConclusionIncidence of Nd:YAG capsulotomy due to the choice of IOL could significantly affect healthcare budgets in the post-cataract surgery period. Our analysis indicates that single-piece monofocal AcrySof IOLs is the most cost-saving treatment option for health care systems when compared to other acrylic single-piece IOLs.

Costs and Healthcare Resource Utilization Associated with Posterior Capsule Opacification After Cataract Surgery with Five Different Intraocular Lenses: An Economic Analysis for Spain

“… 27 Our findings are in line with a previous study which was conducted in UK, Italy and Denmark which showed that hydrophobic IOLs were associated with a lower risk of PCO and Nd:YAG capsulotomy, resulting in a lower costs in total compared to hydrophilic IOLs. 26 Economic studies comparing costs related to cataract surgery with hydrophobic and hydrophilic IOLs in Poland, Germany and Netherlands showed similar results. 33–35 In the current study the difference in Nd:YAG incidence rate between hydrophilic IOLs with hydrophobic surface and without hydrophobic surface was slightly lower.…”

“…Previous research indicates that hydrophobic IOLs are associated with a substantially lower incidence of Nd:YAG compared to other IOL material types. 17–20 , 36 , 37 Our work and the work of others 25 , 26 suggests that they will be associated with substantially lower costs. It has been hypothesized that a lower water content and higher fibronectin bio-adhesion properties of hydrophobic acrylic IOLs may account for the beneficial effects with respect to PCO incidence and related complications.…”

“… Notes : HCP, healthcare personnel, a values are based on the 1647 YAG eyes within three years. 26 bCost of hospital specialist per minute is €0.609, 29 therefore Cost for hospital HCP = Time for hospital HCP × 0.609. c Each Nd:YAG treatment costs €242.48. d Each Nd:YAG treatment on average takes the hospital HCP 30 mins.…”

“…We first computed odds ratios (OR) and three-year incidence rates of Nd:YAG capsulotomy by IOL type. Subsequently, a similar cost-consequence model to the one reported by Dhariwal et al (2019) 26 was used to quantify the health care resource utilization and cost impact of Nd:YAG capsulotomy by IOL type (AcrySof, LLASY60, Bi-flex, Stabibag and CT Asphina). Costs associated with Nd:YAG treatment and its related complications up to three years after cataract surgery were analyzed from the perspective of payers.…”

Early-Onset Posterior Capsule Opacification: Incidence, Severity, and Risk Factors

“…Neodymium-yttrium aluminum garnet (Nd:YAG) capsulotomy is commonly used for treatment for PCO. Nevertheless, it may induce vision-related complications such as ocular inflammation, cystoid macular edema, and retinal detachment [4][5][6], and gives rise to a large financial burden on the health care system [7,8].…”