Cost of cataract surgery after implantation of three intraocular lenses

Figures & data

Figure 1 Annual rates of patients not undergoing Nd-Yag per lens according to two levels of extrapolation.

Table 1 Medical consumption according to the type of side effects

Post-laser Nd-Yag side effects	% of patients affected	Consultations (n)	Treatments	Examinations	Hospitalizations
Transient increase in IOP	5.00%	2	Timolol + xalatan, azopt (50%)	Visual field + gonoscopy (50%)	–
Glaucoma and persistent elevation of IOP	Glaucoma: 1.34% IOP: 1.00%	2.5	Timolol + xalatan or azopt (50%) + betoptic	Visual field + gonoscopy (50%)	Trabeculotomy in 24.2% of cases. CCAM
Cystoid macular edema	1.20%	3.5	Indocollyre + timolol or azopt (50%)	Angiography (50%)	–
Detachment of the retina	1.20%	1	–	–	02C02V/02C02W detachment of the retina
Decrease in visual acuity	4.00%	3		Angiography
Elschnig pearls	47.60%	1	Indocollyre + laser Nd-Yag in 25% of cases

Abbreviations: CCAM, Classification Commune des Actes Médicaux; IOP, intraocular pressure; Nd-Yag, neodymium-Yag.

Table 2 Unit costs of laser Nd-Yag and its complications

Post-laser Yag complications	Cost in the 1st year (€)	Annual cost in the following years (€)
Laser Nd-Yag	98.16	0
Transient increase in intraocular pressure	62.16	0
Persistent increase in intraocular pressure	277.30	277.30
Glaucoma (direct costs)	277.30	277.30
Cost of low vision	7,242	7,242
Cost of blindness	15,679	15,679
Macular edema	108.13	0
Detachment of the retina	3023.54	0
Decrease in visual acuity	96.32	0
Elschnig pearls	36.31	0

Abbreviation: Nd-Yag, neodymium-Yag.

Table 3 Lifetime cost of post-capsulotomy complications per patient and according to type of lens, according to the method of extrapolation used (€)

	SA60AT	AR40E	XL-Stabi
Linear extrapolation of the rate of Yag at 5 and 6 years follow-up, and then a constant rate
Laser Nd-Yag	21.29	44.92	67.46
Transient increase in IOP	0.67	1.42	2.14
Persistent increase in IOP	6.35	13.24	20.26
Persistent increase in IOP leading to blindness (indirect costs)	18.09	37.35	58.13
Glaucoma (direct costs)	8.51	17.74	27.15
Glaucoma leading to blindness (indirect costs)	24.24	50.05	77.90
Macular edema	0.28	0.59	0.89
Detachment of the retina	7.83	16.52	24.80
Decrease in visual acuity	8.82	18.40	28.15
Elschnig pearls	3.75	7.91	11.88
Direct costs	57.49	120.74	182.71
Indirect costs	42.34	87.40	136.03
Total	99.83	208.15	318.74
Total discounted at 5%	81.41	170.37	259.63
Linear extrapolation of the rate of Yag from 5 to 26 years of follow-up
Laser Nd-Yag	22.48	47.85	70.84
Transient increase in IOP	0.71	1.51	2.24
Persistent increase in IOP	6.61	13.89	21.01
Persistent increase in IOP leading to blindness (indirect costs)	18.68	38.67	59.69
Glaucoma (direct costs)	8.86	18.61	28.16
Glaucoma leading to blindness (indirect costs)	25.03	51.82	79.99
Macular edema	0.30	0.63	0.94
Detachment of the retina	8.31	17.69	26.18
Decrease in visual acuity	9.19	19.29	29.19
Elschnig pearls	3.96	8.42	12.47
Direct costs	60.46	127.89	191.03
Indirect costs	43.71	90.49	139.68
Total	104.17	218.38	330.71
Total discounted at 5%	84.78	178.31	268.90
Cost at 5 years
Direct costs	30.79	62.52	100.17
Indirect costs	0.97	2.21	3.08
Total	31.76	64.73	103.25

Abbreviation: Nd-Yag, neodymium-Yag; IOP, intraocular pressure.

Table 4 Budget impact on the Social Security of post-capsulotomy complications for all cataract interventions, per type of lens, according to the method of extrapolation (€)

	SA60AT	AR40E	XL-Stabi	Total difference*
Current market share	204,045	63,598	74,198	341,842
With linear adjustment of the rate of Yag at 5 and 6 years follow-up, then a constant rate
Costs with current market share	18,459,158	12,053,962	21,365, 979	51,879,100 Reference
Hypothesis 1: All interventions with SA60AT	30,925,117			30,925,117−20,953,983
Hypothesis 2: All interventions with AR40E		64,790,569		64,790,569 12,911,469
Hypothesis 3: All interventions with XL-Stabi			98, 436, 469	98,436,469 46,557,369
With linear adjustment from 5 to 26 years of follow-up
Costs with current market share	19,337,675	12,721,852	22,274,013	54,333,540 Reference
Hypothesis 1: All interventions with SA60AT	32,396,919			32,396,919−21,936,621
Hypothesis 2: All interventions with AR40E		68,380,507		68,380,507 14,046,967
Hypothesis 3: All interventions with XL-Stabi			102,619,925	102,619,925 48,826,385

* Difference: (Hypothesis i) – (Costs with current market share). A negative figure is associated with saving.