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. 2019 Jan 14:13:169-176.
doi: 10.2147/OPTH.S190754. eCollection 2019.

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

Mukesh Dhariwal  1 , Christine Bouchet  2 , Shantanu Jawla  3
Affiliations

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

Mukesh Dhariwal et al. Clin Ophthalmol. .

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.

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Conflict of interest statement

Disclosure MD (Alcon Laboratories, Inc.), CB (Novartis Pharma AG), and SJ (Novartis Healthcare Pvt. Ltd.) are Novartis employees. The authors report no other conflicts of interest in this work.

Figures

Figure 1
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
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
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.
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