A cost-effectiveness analysis of femtosecond laser-assisted cataract surgery (FLACS) has thrown shade on the procedure, in comparison with standard phacoemulsification cataract surgery (PCS).
The study, published in JAMA Ophthalmology, concluded that “additional research and development on FLACS is needed to improve its effectiveness and lower its price”.1
The French study found FLACS not only cost more than PCS but yielded less improvement in quality-adjusted life years (QALY) versus PCS (0.788 vs 0.792). The cost of surgery averaged €1,124 for FLACS and €565.50 for PCS. The total cost of care at 12 months averaged €7,085 for FLACS and €6,502 for PCS.
The authors calculated an incremental cost-utility ratio of -€136,476 or US$150,000, reported Dr Antoine Bénard of the University of Bordeaux in France, and co-authors. This put it outside the US$50,000 to US$100,000 per QALY range frequently cited as cost effective.
In invited commentary published in the same edition of JAMA Ophthalmology, Dr Oliver Schein from John Hopkins University School of Medicine said FLACS was introduced into cataract surgical practice about 12 years ago “with much excitement and anticipation”.2
“Here was an elegant procedure with the promise of greater precision and enhanced clinical outcomes compared with conventional ultrasound phacoemulsification for cataract surgery, the most performed operation.
“For many years, achievement of that promise was claimed based on small studies from enthusiastic early adopters. However, the strength of evidence showing no incremental benefit is now substantial,” Dr Schein wrote.
References
1. Bénard, A., Sitta, R., Brezine, A.P., et al., Cost utility of value of information analysis of femtosecond laser-assisted cataract surgery, JAMA Ophthalmol 2023; doi: 10.1001/jamaophthalmol.2023.1716.
2. Schein, O.D., Femtosecond Laser-Assisted Cataract Surgery—Conclusive Evidence of Lack of Incremental Value. JAMA Ophthalmol. Published online 18 May 2023. doi:10.1001/jamaophthalmol.2023.1828
