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

Purpose: The 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 methods: A 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.

Results: For 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).

Conclusion: Incidence 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.

Keywords: AcrySof; IOL; Nd:YAG capsulotomy; PCO; cataract; cost.

Figure 1

Three years cumulative Nd:YAG capsulotomy incidence. Note: Error bars represent 95% CIs. 95% CIs for the estimated Nd:YAG laser capsulotomy rates are as follow: AcrySof: 2.1%–2.6%, AMO Tecnis: 4.8%–5.5%, B&L Akreos: 8.6%–9.8%, Lenstec Softec: 11.5%–13.1%, and Rayner C-/Super-flex: 11.6%–13.6%. Three-year incidence of Nd:YAG capsulotomy after cataract surgery with AcrySof IOLs and non-AcrySof IOLs was derived from a real-world evidence study. Abbreviations: IOLs, intraocular lenses; Nd:YAG, neodymium-doped yttrium aluminum garnet laser.

Figure 2

Estimated rates of complications at 3 years after Nd:YAG capsulotomy. Note: Three-year post-Nd:YAG capsulotomy risk probability of RD, glaucoma, and CME was estimated using weighted average of published rates from studies retrieved through a systematic literature search. Abbreviations: CME, cystoid macular edema; Nd:YAG, neodymium-doped yttrium aluminum garnet laser; RD, retinal detachment.

Figure 3

Total annual cost savings and cost difference per procedure with AcrySof vs other IOLs. Notes: (A) Total annual cost savings with the use of AcrySof over other IOLs in the three countries. Error bars represent CIs. (B) Cost difference per IOL procedure – AcrySof vs other IOLs. Abbreviation: IOLs, intraocular lenses.