Dhariwal Mukesh, Bouchet Christine, Jawla Shantanu
Global Health Economics & Outcomes Research, Alcon Laboratories, Inc., Fort Worth, TX, USA,
Global Patient Access, Novartis Pharma AG, Basel, Switzerland.
Clin Ophthalmol. 2019 Jan 14;13:169-176. doi: 10.2147/OPTH.S190754. eCollection 2019.
The objective of this study was to estimate the cost impact of neodymium-doped yttrium aluminum garnet (Nd:YAG) laser capsulotomy and its complications due to single-piece acrylic monofocal intraocular lenses (IOLs) in the healthcare setting of United Kingdom, Italy, and Denmark.
A hypothetical cost-consequence model was developed to estimate economic burden of Nd:YAG laser capsulotomy due to different single-piece acrylic monofocal IOLs. Cumulative incidence of Nd:YAG laser capsulotomy at 3 years after cataract surgery with five single-piece monofocal acrylic IOLs was sourced from retrospective data analysis of electronic medical records of cataract patients in the United Kingdom. Risk probability of post-Nd:YAG laser complications, ie, retinal detachment, glaucoma, and cystoid macular edema at 3 years was derived using published literature. Unit costs were taken from publicly available sources with all costs converted to euro (€). Number of cataract procedures per year for each country was sourced from Eurostat statistics.
For the estimated cataract procedures carried out nationally every year, single-piece monofocal hydrophobic AcrySof IOL was associated with substantially lower cases of Nd:YAG laser capsulotomy procedures and subsequent complications in 3 years after cataract surgery when compared to other single-piece monofocal acrylic IOLs. The total cost savings with the use of AcrySof over other IOLs in countries assessed ranged from €0.5 to €4.7 million (vs AMO Tecnis) and €2.1 to €17.9 million (vs Rayner C-/Super-flex).
Incidence of Nd:YAG capsulotomy due to the choice of IOL could significantly affect healthcare budgets in the post-cataract surgery period. Our analysis indicates that single-piece monofocal AcrySof IOLs is the most cost-saving treatment option for health care systems when compared to other acrylic single-piece IOLs.
本研究的目的是评估在英国、意大利和丹麦的医疗环境中，掺钕钇铝石榴石（Nd:YAG）激光晶状体囊切开术及其因单片丙烯酸单焦点人工晶状体（IOL）引发的并发症所产生的成本影响。
建立了一个假设的成本后果模型，以估计不同单片丙烯酸单焦点IOL导致的Nd:YAG激光晶状体囊切开术的经济负担。白内障手术后3年使用五种单片单焦点丙烯酸IOL进行Nd:YAG激光晶状体囊切开术的累积发生率，源自英国白内障患者电子病历的回顾性数据分析。Nd:YAG激光术后并发症（即3年后视网膜脱离、青光眼和黄斑囊样水肿）的风险概率，通过已发表的文献得出。单位成本取自公开可用来源，所有成本均换算为欧元（€）。每个国家每年的白内障手术数量源自欧盟统计局的统计数据。
对于每年在全国范围内估计进行的白内障手术，与其他单片单焦点丙烯酸IOL相比，单片单焦点疏水型AcrySof IOL在白内障手术后3年与Nd:YAG激光晶状体囊切开术及后续并发症的病例数大幅减少相关。在评估的国家中，使用AcrySof相对于其他IOL的总成本节省范围为0.5百万欧元至470万欧元（与AMO Tecnis相比）以及210万欧元至1790万欧元（与Rayner C-/Super-flex相比）。
由于IOL选择导致的Nd:YAG晶状体囊切开术发生率，可能会对白内障手术后时期的医疗预算产生重大影响。我们的分析表明，与其他丙烯酸单片IOL相比，单片单焦点AcrySof IOL对医疗系统而言是最具成本效益的治疗选择。
