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The health economic impact of posterior capsule opacification in Finland comparing the two single‐piece intraocular lenses: a cost–consequence analysis

2019; Wiley; Volume: 97; Issue: 8 Linguagem: Inglês

10.1111/aos.14139

1755-3768

Alexander Aaronson, Andrzej Grzybowski, Raimo Tuuminen,

Ocular Infections and Treatments

Posterior capsule opacification (PCO) is the most common postsurgical complication of cataract surgery with an incidence ranging from <5% to as high as 50% (Fong et al. 2014). Clinically significant PCO is treated by Nd:YAG laser capsulotomy. This treatment bears a cost, and its provision can place a burden on resource-constrained healthcare systems (Cullin et al. 2014). Furthermore, although generally considered a safe procedure, Nd:YAG laser capsulotomy is associated with a risk of complications such as elevated intraocular pressure, cystoid macular oedema, intraocular lens (IOL) dislocation and retinal detachment (Cullin et al. 2014). The objective of this research was to estimate the health economic impact of PCO, according to the choice of IOL (AcrySof® SN60WF, Alcon and Tecnis® ZCB00, Johnson & Johnson Vision) from both the hospital and the Finnish healthcare system perspectives. The original study was carried out as a retrospective cohort study at the Ophthalmology Unit of Kymenlaakso Central Hospital, Kotka, Finland (Lindholm et al. 2019). This research adapts the findings of the original competing risks survival analysis to include an economic assessment which focuses on the reported Nd:YAG laser capsulotomy rates of the two single-piece acrylic IOLs (Andersen et al. 2012). A cost–consequence model was developed comparing healthcare resource utilization and costs associated with PCO. Cumulative incidence of Nd:YAG laser capsulotomy at 5 years postcataract surgery with SN60WF (11.5%) and ZCB00 (18.1%) from the RWE study findings underpinned the analysis. The average number of annual cataract procedures at the study site was used for the hospital-level analysis and Eurostat for the national estimate. The Nd:YAG procedure and associated additional consultation visit costs (0.5 preoperatively and 1.0 postoperatively) were assumed to be € 150 and € 95, respectively. An adjustment was made to account for 25% immediate sequential bilateral Nd:YAG laser capsulotomies. Indirect costs, such as travel, and caregivers' time were not considered in the analysis. In the hospital-level analysis, assuming 2080 annual cataract procedures, AcrySof® SN60WF was associated with a reduction of 103 Nd:YAG procedures, 5 years postcataract surgery compared to Tecnis® ZCB00. Extrapolating to the national level resulted in a reduction of 2969 Nd:YAG procedures. Translated into potential cost savings for the hospital and the Finnish healthcare system, the estimates were € 30 116 and € 868 334 (Table 1). Moreover, assuming 30 min for the Nd:YAG laser appointment and associated consultations, time saved estimate was 464 working days, extrapolating to the annual population of Finnish cataract patients (Table 1). Indirect costs from patient travel and caregivers' time, challenges related to loss of full binocular vision, which may not only affect the quality of vision and life, but also predispose patients to an increased risk of falling and traffic accidents, as well as secondary Nd:YAG-related complications should be acknowledged in the evaluation of the economic impact of PCO. This economic analysis of real-world evidence outcomes highlights that the choice of IOL for cataract surgery, as a direct consequence of lower Nd:YAG laser capsulotomy rates, may translate into significant savings both financially and with respect to resource allocation for governmental hospitals and the tax-financed national healthcare system. Further research is warranted to estimate the incidence and costs associated with the complications of the Nd:YAG laser capsulotomy procedure (Billotte & Berdeaux 2004).