Cost-effectiveness of femtosecond cataract surgery
Reviewed by Brian Ang

Femtosecond laser-assisted cataract surgery has become increasingly popular due to the reported benefits of increasing precision and reproducibility of capsulorrhexis, less power and manipulation required during phacoemulsification, better corneal wound architecture, and the ability to place precise arcuate keratotomy incisions if required. With these benefits, it is hoped that there will be improved visual acuity and refractive outcomes, as well as reduced incidence of intraoperative and postoperative complications. However, this technology comes at a cost premium. In this paper, the authors calculate the cost-effectiveness of femtosecond laser-assisted cataract surgery compared to normal phacoemulsification cataract surgery. Using a series of estimates and assumptions, including in the calculation of utility values and quality-adjusted life-years (QALY), the authors found that the cost-effectiveness of using femtosecond laser-assisted cataract surgery was $102,691 per QALY. When calculated relative to routine phacoemulsification cataract surgery, the cost per QALY for femtosecond laser-assisted cataract surgery was $92,862, indicating lack of cost-effectiveness. Femtosecond laser-assisted cataract surgery remained non-cost-effective even when modelling a best-case scenario with 100% visual outcomes, no complications, and at reduced cost to patients. The authors calculated that for cost-effectiveness to be achieved, the cost of femtosecond laser-assisted cataract surgery needs to decrease by at least 50% to 70%. Public hospitals are therefore unlikely to adopt this technology due to the high additional cost and marginal benefits over what is already a very safe and effective cataract surgery technique.

Cost-effectiveness of femtosecond laser-assisted cataract surgery versus phacoemulsification cataract surgery.
Abell RG, Vote BJ.
OPHTHALMOLOGY
2014;121:10-6.