Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Jul 1;141(7):625-629.
doi: 10.1001/jamaophthalmol.2023.1716.

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

Antoine Bénard  1   2 , Remi Sitta  1 , Antoine Pierre Brezin  3 , Beatrice Cochener  4 , Dominique Monnet  3 , Philippe Denis  5 , Pierre-Jean Pisella  6 , Nathalie Hayes  7 , Cedric Schweitzer  2   8 ; FEMCAT Study Group
Collaborators, Affiliations

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

Antoine Bénard et al. JAMA Ophthalmol. .

Abstract

Importance: The 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.

Objective: To estimate the cost utility of FLACS compared with phacoemulsification cataract surgery (PCS) on a 12-month time horizon.

Design, setting, and participants: This 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.

Interventions: FLACS or PCS.

Main outcomes and measures: Utility 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.

Results: Of 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 relevance: The 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 registration: ClinicalTrials.gov Identifier: NCT01982006.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest Disclosures: Dr Bénard has received grants from French Ministry of Social Affairs and Health during the conduct of the study. Dr Brezin has received personal fees from Alcon and Johnson & Johnson and is a member of the iLasis data safety monitoring board outside the submitted work. Dr Cochener has received personal fees from Johnson & Johnson during the conduct of the study; grants from Alcon, SIFI, and Bausch & Lomb; and personal fees from Santen, Shire, Novartis, Hoya, Horus, Thea, Cutting Edge, and Zeiss outside the submitted work; is president of the French Academy of Ophthalmology; and is past president of the French Society of Ophthalmology and the European Society of Cataract and Refractive Surgery. Dr Monnet has received personal fees from Alcon, Bausch & Lomb, and Hoya outside the submitted work. Dr Denis has received personal fees from Alcon, AbbVie, Horus, Santen, and Thea outside the submitted work and is past president of the French Society of Ophthalmology and French Glaucoma Society. Dr Pisella has received personal fees from Alcon, Novartis, Santen, Shire, and Thea outside the submitted work and is past president of the French Society of Ophthalmology. Dr Hayes has received grants from the French Ministry of Health during the conduct of the study. Dr Schweitzer has received personal fees from AbbVie, Thea, Nicox, Horus, Johnson & Johnson, Alcon, Glaukos, Santen, and Bausch & Lomb outside the submitted work. No other disclosures were reported.

Figures

Figure.
Figure.. Cost-effectiveness Acceptability Curve of Femtosecond Laser–Assisted Cataract Surgery (FLACS) Compared With Phacoemulsification Cataract Surgery (PCS) on 12-Month Time Horizon
QALY indicates quality-adjusted life-year.
See this image and copyright information in PMC

Comment in

References

    1. Eyewire News . Cataract surgery products continue to be the main single-use surgical device sales driver. Accessed September 20, 2019. https://eyewire.news/articles/cataract-surgery-products-continue-to-be-t...
    1. Brown GC, Brown MM, Menezes A, Busbee BG, Lieske HB, Lieske PA. Cataract surgery cost utility revisited in 2012: a new economic paradigm. Ophthalmology. 2013;120(12):2367-2376. doi:10.1016/j.ophtha.2013.04.030 - DOI - PubMed
    1. Lam D, Rao SK, Ratra V, et al. . Cataract. Nat Rev Dis Primers. 2015;1:15014. doi:10.1038/nrdp.2015.14 - DOI - PubMed
    1. Schweitzer C, Brezin A, Cochener B, et al. ; FEMCAT study group . Femtosecond laser-assisted versus phacoemulsification cataract surgery (FEMCAT): a multicentre participant-masked randomised superiority and cost-effectiveness trial. Lancet. 2020;395(10219):212-224. doi:10.1016/S0140-6736(19)32481-X - DOI - PubMed
    1. Day AC, Burr JM, Bennett K, et al. ; FACT group . Femtosecond Laser-Assisted Cataract Surgery Versus Phacoemulsification Cataract Surgery (FACT): a randomized noninferiority trial. Ophthalmology. 2020;127(8):1012-1019. doi:10.1016/j.ophtha.2020.02.028 - DOI - PMC - PubMed

Publication types

Associated data