Lens choice affects cost in treating unilateral congenital cataract

Orlando—Treatment of unilateral congenital cataract with a posterior chamber (PC) IOL is 15% less expensive than treatment with aphakic contact lenses when estimating the cost of therapy for 2 years, according to a recent cost analysis.

The higher cost of aphakic lenses and replacements for lost lenses was responsible for the difference between the two procedures. According to the analysis, the 2-year cost of treatment with a PC IOL was $20,945, compared with $24,739 for treatment with an aphakic contact lens. Michael Straiko, MD, performed the analysis during his final year as medical student at the University of Cincinnati College of Medicine and presented it as a poster at the recent meeting of the American Academy of Pediatric Ophthalmology and Strabismus. Dr. Straiko is now spending a preliminary year in internal medicine at Christ Hospital in Cincinnati.

Increased IOL use in aphakia

Items in the cost analysis included cataract extraction surgery, reoperations, and the expense of lost lenses. Only the first 2 years of what is a life-long intervention were examined. This was in order to study the age range for which most follow-up data are available, to target the time period in which opacification usually occurs, and to reduce the number assumptions that would have to be made, Dr. Straiko said.

In estimating the cost of treatment with contact lenses, Dr. Straiko added the costs of surgery, reoperation, and complications to the average cost of a Bausch & Lomb SilSoft lens, the brand most commonly used for aphakic correction. The costs of lens replacement and lens fittings were also calculated, using an estimate of 22.8/eye/year for the first 6 months and 12/eye/year for the remaining 18 months.

"Part of that was because of prescription changes and part of it was due to lens loss," Dr. Straiko said. He added that estimates of lens loss rates are a limitation of the study because little information on this topic has been reported in the literature.

While the analysis of contact lens costs included reoperations, procedures for secondary IOL insertion were omitted from that category. These procedures were not included because they often fall outside the 2-year window established for this study and because there are few data on the frequency of such procedures, Dr. Straiko said.

However, because one study estimated that about one-third of aphakic patients later undergo IOL insertion, the costs could be significant, he added.

For IOLs, factors analyzed included the costs of cataract extraction and IOL implantation surgery, reoperations to clear the visual axis of pupillary membrane or cortex proliferation or to repair iris abnormalities, and use of soft contact lenses for overcorrection to achieve emmetropia. The same replacement rate was used for these lenses as for those used as primary therapy for aphakic correction.

Obtaining estimates for the cost of surgery proved challenging. Dr. Straiko initially planned to use the Medicare fee schedule but concluded that those figures were unrealistically low. Instead, he used an average derived from the cost of cases performed at Cincinnati Children's Hospital Medical Center.

Overall, costs were examined from what Dr. Straiko referred to as a "societal viewpoint" rather than a consumer viewpoint by considering the total reimbursable costs rather than the true costs incurred by each consumer. Differences in reimbursement rates paid by insurance companies and the differences consumers experience in premiums and deductibles made that calculation too complex for purposes of this study, as did the issue of whether consumers have insurance coverage of any kind, he said.

However, Dr. Straiko estimated that aphakic patients and their families would probably experience higher out-of-pocket expenses because contact lenses, unlike surgery, are not typically covered by insurance.

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