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Cost-utility of femtosecond laser-assisted cataract surgery compared to phacoemulsification cataract surgery in a randomised participant-blinded controlled trial: the FEMCAT* Study

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First Author: C.Schweitzer FRANCE

Co Author(s):    N. Hayes   A. Brezin   B. Cochener   P. Denis   P. Pisella   A. Benard     

Abstract Details

Purpose:

To estimate the cost-utility of femtosecond laser assisted cataract surgery (FLACS) compared to phacoemulsification cataract surgery (PCS) in the FEMCAT (impact Médico-Economique de la chirurgie de la CAtaracte au laser Femtoseconde) study (ClinicalTrials.gov: NCT01982006).

Setting:

University hospital of Bordeaux (France), and Lyon, Tours, Paris and Brest University Hospitals (France)

Methods:

The FEMCAT study is a prospective multicenter participant-blinded randomized clinical trial comparing FLACS and PCS in two parallel patient group. Consecutive patients eligible for unilateral or bilateral cataract surgery were included. Utility scores were measured through the Health Utility Index questionnaire (HUI-3) at pre-inclusion, month-3 and month-12 postoperative visits. Costs of cataract surgery were estimated by a microcosting approach. All inpatient and outpatient costs arising across the 12-month follow-up were collected from the French National Health Data System, a claim database encompassing 98.8% of the French population. Our primary endpoint was the incremental cost per additional QALY at 12 months.

Results:

907 patients (1476 eyes) were randomized. 440 patients in the FLACS group and 430 in the PCS group were analyzed. The mean age was 72.3+/-8.6 years and the rate of bilateral surgery was 63.3%. The mean costs of cataract surgery estimated by microcosting were 1119.7+/-162.2€ and 565.5+/-61.4€ for FLACS and PCS, respectively. At 12-month visit, total mean costs of care were 6490+/-324€ for FLACS and 6253+/-318€ for PCS. FLACS yielded a mean of 0.787+/-0.009 QALYs and PCS 0.793+/-0.009. The incremental cost-utility ratio was -40634€/QALY. The cost-effectiveness probability of FLACS compared to PCS was 26.1% for a cost-effectiveness threshold of 30000€/QALY.

Conclusions:

Despite its advanced technology, femtosecond laser was not superior to phacoemulsification in cataract surgery and, in its current state of development, is more costly. Further development is needed for FLACS to provide an additional clinical benefit for patients and to become a cost-effective surgical procedure to treat cataract.

Financial Disclosure:

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