Cost Utility and Value of Information Analysis of Femtosecond Laser–Assisted Cataract Surgery

Abstract

ImportanceThe efficacy and safety of femtosecond laser–assisted cataract surgery is well documented. An important requirement for decision makers is the evaluation of the cost-effectiveness of femtosecond laser–assisted cataract surgery (FLACS) over a sufficiently long horizon. Evaluating the cost-effectiveness of this treatment was a preplanned secondary objective of the Economic Evaluation of Femtosecond Laser Assisted Cataract Surgery (FEMCAT) trial.ObjectiveTo estimate the cost utility of FLACS compared with phacoemulsification cataract surgery (PCS) on a 12-month time horizon.Design, Setting, and ParticipantsThis multicenter randomized clinical trial compared FLACS with PCS in parallel groups. All FLACS procedures were performed using the CATALYS precision system. Participants were recruited and treated in ambulatory surgery settings in 5 university-hospital centers in France. All consecutive patients eligible for a unilateral or bilateral cataract surgery 22 years or older with written informed consent were included. Data were collected from October 2013 to October 2018, and data were analyzed from January 2020 to June 2022.InterventionsFLACS or PCS.Main Outcomes and MeasuresUtility was measured through the Health Utility Index questionnaire. Costs of cataract surgery were estimated by microcosting. All inpatient and outpatient costs were collected from the French National Health Data System.ResultsOf 870 randomized patients, 543 (62.4%) were female, and the mean (SD) age at surgery was 72.3 (8.6) years. A total of 440 patients were randomized to receive FLACS and 430 to receive PCS; the rate of bilateral surgery was 63.3% (551 of 870). The mean (SD) costs of cataract surgery were €1124.0 (€162.2; US $1235) for FLACS and €565.5 (€61.4; US $621) for PCS. The total mean (SD) cost of care at 12 months was €7085 (€6700; US $7787) in participants treated with FLACS and €6502 (€7323; US $7146) in participants treated with PCS. FLACS yielded a mean (SD) of 0.788 (0.009) quality-adjusted life-years (QALYs), and PCS yielded 0.792 (0.009) QALYs. The difference in mean costs was €545.9 (95% CI, −434.1 to 1525.8; US $600), and the difference in QALYs was −0.004 (95% CI, −0.028 to 0.021). The incremental cost-effectiveness ratio (ICER) was −€136 476 (US $150 000) per QALY. The cost-effectiveness probability of FLACS compared with PCS was 15.7% for a cost-effectiveness threshold of €30 000 (US $32 973) per QALY. At this threshold, the expected value of perfect information was €246 139 079 (US $270 530 231).Conclusions and RelevanceThe ICER of FLACS compared with PCS was not within the $50 000 to $100 000 per QALY range frequently cited as cost-effective. Additional research and development on FLACS is needed to improve its effectiveness and lower its price.Trial RegistrationClinicalTrials.gov Identifier: NCT01982006

Incidence of Nd:YAG laser capsulotomy following cataract surgery: a population-based nation-wide study – FreYAG1 study

“…As specified above, and as shown in NOD audit, these factors can change the outcomes of a surgery, notably in terms of PCO rate [ 5 ]. However, the FEMCAT economic study showed that FLACS technique remains rarely used due to a relative lack of medico-economic advantage; and Monnet et al multicentric analysis showed that multifocal implants represented around 6% of the IOLs in 2021 [ 36 , 37 ]. These results tend to limit the potential biases due to the differences in practices.…”

Editorial: Innovations in cataract surgery

“…The introduction of Femtosecond Laser-Assisted Cataract Surgery (FLACS) in the early 2010s initially seemed like a revolutionary leap. Yet, a decade later, it needs to work on becoming the standard due to its higher costs, operational challenges in the operating room, and marginal benefits over traditional phacoemulsification ( 7 ). Despite these innovative steps, the question arises whether we have reached a peak in cataract surgery innovation.…”