The Economics of Femtosecond Laser-assisted Cataract Surgery

John D. Bartlett; Kevin M. Miller


Curr Opin Ophthalmol. 2016;27(1):76-81. 

In This Article

Femtosecond Laser-assisted Cataract Surgery

FLACS is an exciting new technology. Surgeons are always looking for ways to improve treatment delivery. Ophthalmologists have seen disruptive changes in cataracts surgery since the 1970s with the institution of phacoemulsification as the dominant mode of surgery and the development of modern intraocular lenses. These have radically changed the surgery from one of last resort for blind patients to a high-tech refractive procedure with which patients expect not only improved vision, but also a decreased need for glasses if not outright spectacle independence.

With the success of femtosecond technology in LASIK, it was logical for industry to seek FDA approval for the use of femtosecond lasers in cataract surgery. What is less clear is whether or not FLACS will become the dominant mode of cataract surgery in the future. The debate can be framed from a technical standpoint; does FLACS result in a measurably better surgery, with better results?[8,9] Current studies show some theoretical advantages in terms of the circularity of the capsulorrhexis, predictability of the effective lens position calculation, decreased total ultrasound energy with resultant decreased endothelial cell injury, and reproducibility of corneal incisions including peripheral corneal relaxing incisions.[10,11] Although there is a large multicenter French trial underway currently,[12] there is a dearth of published studies showing actual improved outcomes. At the very least, FLACS does not seem to have inferior outcomes to traditional cataract surgery once the initial learning curve is mastered.[13]

Aside from arguing the added clinical benefit, a significant portion of the debate will be centered around finances. FLACS is much more expensive. If FLACS becomes the standard for cataract surgery, the societal cost for cataract care will rise significantly and the individual cost to patients will be higher. Already, we have some inkling that from a cost-effectiveness stand point FLACS may not make sense.

Currently, cataract surgery is one of the most cost-effective interventions in the world at about US $4378 per quality adjusted life year (QALY). By comparison, even with generous estimates of additional benefits and a low US $300 additional patient cost for FLACS yielded US $57 000 per QALY, a drastic reduction in cost–effectiveness, although not outside the range of other commonly delivered interventions like the treatment of hypertension (~US $40 000/QALY).[14]