No Reimbursements for Femtosecond Cataract Surgery, Trial Recommends

Femtosecond laser-assisted cataract surgery, in its current state of development, does not match the cost-effectiveness of conventional phaceoemulsification cataract surgery.

Femtosecond cataract surgery is not cost-effective and “should not be reimbursed by health care systems,” according to research published in JAMA Ophthalmology. The incremental cost-effectiveness ratio (ICER) of femtosecond laser-assisted cataract surgery (FLACS) compared with phacoemulsification cataract surgery (PCS) is not within the range of cost-effectiveness, the investigation shows.

Researchers conducted a secondary analysis of the Economic Evaluation of Femtosecond Laser Assisted Cataract Surgery Trial (FEMCAT, Identifier: NCT01982006) to compare the cost utility of femtosecond cataract surgery with PCS.

The study included 870 participants (mean age, 72.3 years; 62.4% women). Patients were randomly assigned to receive either femtosecond cataract surgery (n=440) or PCS (n=430), with 63.3% of the total receiving bilateral cataract surgery. The study found that the mean costs of cataract surgery were $1235 for FLACS and $621 for PCS.

All these results are very consistent, with outcomes of FLACS and PCS very close to each other and always to the disadvantage of FLACS.

The total mean cost of care at 12 months was $7787 in participants treated with femtosecond cataract surgery and $7146 in participants treated with PCS. FLACS yielded a mean of 0.788 quality-adjusted life-years (QALYs), and PCS yielded 0.792 QALYs. The difference in mean costs was $600, and the difference in QALYs was -0.004 (95% CI, -0.028 to 0.021). The ICER was $150,000 per QALY.

The cost-effectiveness probability of femtosecond cataract surgery compared with PCS was 15.7% for a cost-effectiveness threshold of $32,973 per QALY. The expected value of perfect information (EVPI) at this threshold was $270,530,231.

The researchers explain that the cost-utility analysis of the previous Femtosecond Laser-Assisted Cataract Surgery Versus Phacoemulsification Cataract Surgery (FACT) trial also reported a very small difference in costs between PCS and FLACS, further validating the study’s findings.

“All these results are very consistent, with outcomes of FLACS and PCS very close to each other and always to the disadvantage of FLACS,” the study authors note. “This is a sign of robustness of our results.”

Study limitations include small sample size, and the fact that the study’s value of information analysis was limited to the calculation of EVPI.


Benard A, Sitta R, Brezin AP, et al. Cost utility and value of information analysis of femtosecond laser-assisted cataract surgery. JAMA Ophthalmology. Published online May 18, 2023. doi:10.1001/jamaophthalmol.2023.1716.