OBJECTIVES

Cataract surgery is the most frequently performed surgical procedure in Belgium. Posterior capsule opacification (PCO) is the most common complication of cataract surgery and requires a secondary treatment: Nd:YAG capsulotomy. This procedure is usually safe, however, could lead to complications such as retinal detachment (RD), glaucoma, and cystoid macular edema (CME). The aim of this analysis was to estimate the cost impact of Nd:YAG procedures due to AcrySof vs. other single-piece acrylic IOLs, reflecting the Belgian setting.

METHODS

A cost-consequence model was developed comparing healthcare resource utilization and costs of different single-piece acrylic IOLs. The incidence of Nd:YAG at three years post-cataract surgery with five single-piece acrylic IOLs was attained from the literature (2.4% for AcrySof, 5.1% for Tecnis, 9.2% for Akreos, 12.3% for Lenstec and 12.6% for Rayner). Cumulative incidence of post-YAG laser complications at 3 years was estimated using published literature: RD (4.4%), glaucoma (8.8%), and CME (16.9%). Costs were based on published Belgian nomenclature (Nd:YAG: €188.15, Vitrectomy: €762.63 glaucoma: €381.31, CME: €85.99). Number of cataract procedures per year in Belgium was sourced from Eurostat statistics. One associated follow-up visit was assumed per Nd:YAG procedure (€7.48).

RESULTS

For 133,789 cataract procedures carried out in one year, single-piece hydrophobic AcrySof IOLs were found to be associated with significantly lower number of Nd:YAG procedures (cases) 3 years post-cataract surgery when compared to Tecnis (‑3,612), B&L Akreos (‑9,098), Lenstec (‑13,245) and Rayner (‑13,646) with subsequent reductions in RD, glaucoma and CME cases. Potential cost savings for the Belgian healthcare system with the use of AcrySof over other IOLs ranged from €948,894 (vs. Tecnis) to €3,584,712 (vs. Rayner).

CONCLUSIONS

Results highlight that the appropriate choice of IOL for cataract surgery, as a direct consequence of lower ND:YAG capsulotomy rates and associated complications – may translate into significant savings for the Belgian national healthcare system.