OBJECTIVES: Toric IOL rotation post-surgery could impact patient’s visual outcomes leading to unplanned office visits and may require performing Toric IOL repositioning surgery in some cases. The purpose of the analysis is to compare overall clinical workload (post-operative chair-time and operating room time for Toric IOL rotation cases requiring repositioning surgeries) with three hydrophobic acrylic Toric IOLs and estimate opportunity cost for a private Cataract surgery centre in India.

METHODS: A decision analytic model was developed in MS excel to conduct the analysis. Toric IOL repositioning surgery incidence rate for AcrySof (0.2%), Tecnis (1.80%) and Hoya (1.94%) Toric IOLs was sourced from a published study. Annual volume of cataract surgeries with Toric IOLs (N=250) at the centre, overall clinical workload i.e., post-operative chair-time and operating room time for each case requiring Toric IOL repositioning surgery (60 minutes) and foregone office chair-time and operating room cost for the center (INR 45,000) were informed by surgeon inputs.

RESULTS: The model compared three scenarios of annual Toric IOL surgeries (n=250) conducted with AcrySof Toric (Scenario ‘A’), Tecnis Toric (Scenario ‘B’) or Hoya Toric (Scenario ‘C’) IOLs. Overall additional annual clinical workload for the centre in Scenario A, B, and C was estimated to be 30, 270 and 291 minutes respectively. Annual cost impact to the centre to manage cases requiring Toric IOL repositioning surgeries in Scenario A, Scenario B, and Scenario C was estimated to be INR 22,500 (USD 301), INR 202,500 (USD 2,712) and INR 218,475 (USD 2,926) respectively.

CONCLUSIONS: Findings from this decision analytic model indicates a private cataract surgery in India could incur opportunity costs if it performs Toric IOL surgeries with Tecnis Toric or Hoya Toric IOLs due to higher clinical workload and foregone costs in managing Toric IOL rotation cases when compared to AcrySof Toric IOLs.