Financial modeling of femtosecond laser-assisted cataract surgery (FLACS) within the National Health Service (NHS)

Session Details

Session Title: Femtolaser-Assisted Cataract Surgery (FLACS)

Session Date/Time: Sunday 11/09/2016 | 08:00-10:00

Paper Time: 08:12

Venue: Hall C1

First Author: : H.Roberts UK

Co Author(s): :    D. O'Brart                    

Abstract Details

Purpose:

Femtosecond laser assisted cataract surgery (FLACS) is expensive, both in terms of the initial purchase of the laser system and the continued operational costs. As a result, use of FLACS within public health systems such as the National Health Service (NHS) of the United Kingdom is currently minimal. Additional expenditure associated with FLACS may be offset by an increase in surgical efficiency and theatre time utilization. This paper models the additional FLACS-associated costs to identify the thresholds at which various parameters would render the service cost-neutral.

Setting:

The financial data relating to the running costs and overheads of 5 NHS ophthalmology departments providing high volume cataract surgery were obtained. Representative values for initial and running costs were obtained from the 5 manufacturers of the currently available FLACS platforms.

Methods:

A hypothetical financial model was designed to compare FLACS against conventional phacoemulsification surgery (CPS) for the provision cataract surgery within a public healthcare setting. Uni- and bi-variate sensitivity analyses were performed by varying the inputs into the model to simulate the impact on the final service costs. Threshold analyses were performed on the same variables as the sensitivity analysis to determine threshold values at which FLACS may become financially viable.

Results:

6 variables were identified as important parameters to test via threshold and sensitivity analyses. Threshold analyses demonstrated two parameters which were able to render the FLACS service less expensive at realistic values: An increased number of cases per FLACS theatre list compared to CPS (by 100%) or a significant reduction in the cost of the patient interface device (PI) by approximately 70%. Sensitivity analyses revealed a range of values at which FLACS could be financially viable. The price of the laser, the maintenance costs and the number of cataracts performed per annum were not important factors in the overall costs.

Conclusions:

Overall, this model demonstrates that FLACS can only be financially viable within the NHS with an over 100% increase in efficiency and a significant reduction in the cost of the PI. Implementation of FLACS within the NHS would require negotiation with the manufacturers over the cost of the PI and development of surgical models to increase surgical efficiency. Further research is required on the clinical outcomes of FLACS compared with CPS as well as real-world evidence of the effect to surgical efficiency afforded by this technology.

Financial Disclosure:

... research is funded, fully or partially, by a company producing, developing or supplying the product or procedure presented