Cost Utility and Value of Information Analysis of Femtosecond Laser–Assisted Cataract Surgery

Author:

Bénard Antoine12,Sitta Remi1,Brezin Antoine Pierre3,Cochener Beatrice4,Monnet Dominique3,Denis Philippe5,Pisella Pierre-Jean6,Hayes Nathalie7,Schweitzer Cedric28,Piazza Laurent9,Georges Nicolas9,Roseng Stéphanie9,Gimbert Anne9,Regueme Sophie9,Galet Jérome9,Daniel Fabien9,Colin Joseph9,Touboul David9,Chatoux Olivier9,Bardet Emilie9,Bourreau Catherine9,Nicolau Romain9,Guillard Margaux9,Cochard Catherine9,Merce Emilie9,Galliot Florence9,Kodjikian Laurent9,Nguyen Minh9,Fortoul Vincent9,Rateau Jean9,Vandenmeer Guillaume9,Habay Thomas9,Arné Jean-Louis9,Sarragoussi Jean-Jacques9,Albou-Ganem Cati9,

Affiliation:

1. CHU Bordeaux, Public Health Department, Clinical Epidemiology Unit (USMR), Bordeaux, France

2. University Bordeaux, ISPED, INSERM, U1219—Bordeaux Population Health Research Centre, Bordeaux, France

3. AP-HP Cochin, Department of Ophthalmology, University Paris Cité, Paris, France

4. CHU Morvan, Department of Ophthalmology, University Brest, Brest, France

5. CHU Lyon, Croix Rousse, University Lyon, Lyon, France

6. CHU Tours, Department of Ophthalmology, University Tours, INSERM, Tours, France

7. CHU de Bordeaux, Direction de la Recherche Clinique et de l’Innovation, Bordeaux, France.

8. CHU Bordeaux, Department of Ophthalmology, Bordeaux, France

9. for the FEMCAT Study Group

Abstract

ImportanceThe efficacy and safety of femtosecond laser–assisted cataract surgery is well documented. An important requirement for decision makers is the evaluation of the cost-effectiveness of femtosecond laser–assisted cataract surgery (FLACS) over a sufficiently long horizon. Evaluating the cost-effectiveness of this treatment was a preplanned secondary objective of the Economic Evaluation of Femtosecond Laser Assisted Cataract Surgery (FEMCAT) trial.ObjectiveTo estimate the cost utility of FLACS compared with phacoemulsification cataract surgery (PCS) on a 12-month time horizon.Design, Setting, and ParticipantsThis multicenter randomized clinical trial compared FLACS with PCS in parallel groups. All FLACS procedures were performed using the CATALYS precision system. Participants were recruited and treated in ambulatory surgery settings in 5 university-hospital centers in France. All consecutive patients eligible for a unilateral or bilateral cataract surgery 22 years or older with written informed consent were included. Data were collected from October 2013 to October 2018, and data were analyzed from January 2020 to June 2022.InterventionsFLACS or PCS.Main Outcomes and MeasuresUtility was measured through the Health Utility Index questionnaire. Costs of cataract surgery were estimated by microcosting. All inpatient and outpatient costs were collected from the French National Health Data System.ResultsOf 870 randomized patients, 543 (62.4%) were female, and the mean (SD) age at surgery was 72.3 (8.6) years. A total of 440 patients were randomized to receive FLACS and 430 to receive PCS; the rate of bilateral surgery was 63.3% (551 of 870). The mean (SD) costs of cataract surgery were €1124.0 (€162.2; US $1235) for FLACS and €565.5 (€61.4; US $621) for PCS. The total mean (SD) cost of care at 12 months was €7085 (€6700; US $7787) in participants treated with FLACS and €6502 (€7323; US $7146) in participants treated with PCS. FLACS yielded a mean (SD) of 0.788 (0.009) quality-adjusted life-years (QALYs), and PCS yielded 0.792 (0.009) QALYs. The difference in mean costs was €545.9 (95% CI, −434.1 to 1525.8; US $600), and the difference in QALYs was −0.004 (95% CI, −0.028 to 0.021). The incremental cost-effectiveness ratio (ICER) was −€136 476 (US $150 000) per QALY. The cost-effectiveness probability of FLACS compared with PCS was 15.7% for a cost-effectiveness threshold of €30 000 (US $32 973) per QALY. At this threshold, the expected value of perfect information was €246 139 079 (US $270 530 231).Conclusions and RelevanceThe ICER of FLACS compared with PCS was not within the $50 000 to $100 000 per QALY range frequently cited as cost-effective. Additional research and development on FLACS is needed to improve its effectiveness and lower its price.Trial RegistrationClinicalTrials.gov Identifier: NCT01982006

Publisher

American Medical Association (AMA)

Subject

Ophthalmology

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