AcrySof IOLs most cost effective and safe for both payers and hospitals
The global leading cause of partial and complete blindness is cataract. The most commonly performed procedure for the medical treatment of cataracts is a surgery with lens replacement. While safe and effective, the cataract surgery may cause posterior capsule opacification (PCO), which can lead to impaired contrast sensitivity, glare disabilities and reduced visual acuity. PCO is treated with neodymium-doped yttrium aluminum garnet (Nd: YAG) laser capsulotomy. This treatment, in turn, can be associated with further complications, including cystoid macular oedema (CME), late onset endophthalmitis, posterior vitreous detachment, reduction in vision, retinal detachment (RD), or uveitis, all of which affect patients' function of vision and quality of life. Thus, PCO increases the burden to patients and healthcare systems due to the necessary Nd:YAG treatment and possible complications that require further specialist consultation and treatment. Given the sheer volume of cataract surgeries being performed annually, even small differences in costs per patient add up to significant overall costs to the healthcare system. It is therefore important for patients and for healthcare systems more generally to minimize PCO.
Belda et al conducted a study that extended their previous RWE investigation on Nd:YAG incidence after cataract surgery and provides an economic assessment of the financial costs and time investment for payers and hospitals in Spain. The objective was to estimate the health economic impact of five different single-piece, acrylic monofocal IOLs (Alcon AcrySof (hydrophobic), AJL LLASY60, Medicontur Bi-flex, IOL Tech Stabibag (all hydrophilic) and Zeiss Asphina (hydrophilic with a hydrophobic surface) and the costs associated with PCO and the Nd:YAG procedure, as well subsequent complications from both the perspective of payers and hospitals in Spain. When considering not only the cost of the cataract surgery but also its related complications over three years, authors estimated that AcrySof IOLs could substantially reduce the economic burden for payers and save the health care resources in terms of time and money for hospitals, when compared to four other IOLs.
The three-year incidence rates of Nd:YAG laser capsulotomy after cataract surgery with five different single-piece acrylic monofocal IOLs (AcrySof IOLs, AJL LLASY60, IOL Tech Stabibag, Medicontur Bi-flex, Zeiss Asphina) for 8293 patients were derived from odds ratios of multivariate analysis adjusted for age, gender, and diabetic retinopathy. A cost-consequence model for a hypothetical cohort of 2000 eyes was then developed to quantify the potential impact of Nd:YAG capsulotomy in terms of costs and time for each of the included IOLs, from the payer and hospital perspectives.
The adjusted three-year Nd:YAG laser capsulotomy incidence was 5.0% (95% CI 3.9 to 6.1) for AcrySof and ranged from 26.0% to 44.0% for the other four IOLs. The average costs of Nd:YAG treatment and related complications were €261.90 for payers and €19.99 for hospitals. The average time needed for Nd:YAG treatment and related complications was 32.82 minutes. Model estimates based on 2000 hypothetical cataract surgeries showed that AcrySof IOLs could lead to cost savings between €110,259.90 and €205,591.50 for payers. For hospitals, time, and cost savings with AcrySof ranged from 230.29 hours and €8415.79 compared to Zeiss Asphina to 429.40 hours and €15,692.15 compared to AJL LLASY60 IOLs.
When considering not only the cost of the cataract surgery but also its related complications over three years, authors estimated that AcrySof IOLs could substantially reduce the economic burden for payers (from €110,259.90 to €205,591.50) and save the health care resources in terms of time and money for hospitals (from 230.29 to 429.40 hours and €8415 to €15,692), when compared to four other IOLs, including AJL LLASY60, IOL Tech Stabibag, Medicontur Bi-flex and Zeiss Asphina. Study findings highlight the importance of IOL choice with respect to economic costs and resources for both payers and hospitals.
The three-year incidence of Nd:YAG capsulotomy in this expanded RWE study showed the overall incidence rate after cataract surgery was approximately 14%, and rates were significantly lower for AcrySof IOLs (5%) compared to the other included IOLs. The subsequent cost-consequence analysis estimated that IOL choice also reduces the burden on resources for health care providers. This is important, particularly seen through the prism of the COVID-19 pandemic; avoidance of PCO means that patients will have fewer hospital visits and as such, resources can be liberated to elsewhere in eye-care services as well as reducing the risk of infection for patients and healthcare professionals.
This study is the first to report on Nd:YAG capsulotomy treatment related economic impact and to report costs in relation to five different IOL types harnessing RWE data from Spain. The study showed that from the payer and hospital perspectives IOL choice is an important economic factor. AcrySof IOLs are associated with lower costs for both payers and hospital HCP, due to substantial lower Nd:YAG capsulotomy rates and a lower risk for complications in three years after cataract surgery.
Source: Belda et al; Clinical Ophthalmology 2022:16
