Study shows LASIK could provide long-term savings to patients despite initial costs

Stefanie Petrou-Binder MD in Ludwigshafen, Germany

A RECENT German study on the cost-effectiveness of LASIK surgery says patients’ long-term savings far outweigh the initial costs of the procedure.
"No one ever claimed LASIK was cheaper than using glasses. In the long run, however, we found that LASIK had a very good cost-effectiveness relationship," reported Frank Krummenauer MD at the 17th Annual Congress of the German-Speaking Society for Intraocular Lens Implantation and Refractive Surgery (DGII).

His retrospective cohort study, performed in co-operation with H Burkhard Dick MD. University Eye Hospital, Mainz, Germany and Michael C Knorz, FreeVis LASIK Department, Mannheim, Germany contrasted the direct and indirect costs associated with LASIK and the money saved from ongoing eye care using glasses or contact lenses with the postoperative improvement in visual acuity.
The study tracked the expenses incurred by LASIK from the patients’ perspective. These included the direct cost of surgery as well as the income forfeited during the time of surgery and convalescence.

The investigators performed written interviews with patients at two university LASIK centres. The patients were asked to list the funds invested in visual aids before LASIK and then again afterwards, as well as the cost of the surgery itself. The latter were validated by the LASIK centres’ cost documentation.
The 220 patients, with a median age of 38, had all undergone bilateral LASIK surgery in 2001. Seventy cases represented the sum total of LASIK patients operated on at the Mainz University LASIK Centre, Germany in 2001. Another 250 were selected randomly from the LASIK centre’s 2,100-patient database for the same year.

The study showed that patients reported to spend between E200 and E400 (median E250) per year on visual aids - that is, all of the costs associated with glasses, contact lenses and maintenance. These expenses became negligible following refractive correction by LASIK, ranging from zero to ¤20.

Patients paid a median of ¤3,750 (medians of ¤3000 or E3910), for bilateral LASIK, depending on the university centre visited. Associated with a median refractive correction of +6.0 D or +4.0 D in these centres, these costs imply marginal costs effectiveness ratios of ¤667 or ¤831 per gained refractive benefit unit after LASIK.

Indirect costs calculated from lost work days or work days under surgery-associated reduced working efficency amounted approximately to a median of E300. Some 75% of the participating patients were employed full time and 36% of these were given a median of four sick-days for the refractive procedure. Another 64% of the patients took a median of three days off (1.5 to four days) from their own free time to have surgery done.

For the sake of illustration, assuming an average gross income of E100 per day, the indirect LASIK expenses amounted to an average of E300 (E150 to E400) for the individual patient. The expenses incurred by health insurers for the patients operated on on work days amounted to E300 (E200 to E500) for every third procedure done.
Dr Krummenauer explained that the issue of health care claims for LASIK has been and remains a subject of much debate in Germany, since patients typically end up paying a good portion – mostly all - of the costs themselves.

Sceptics have pointed out that the need to reinvest in glasses was inevitable once the patient reached the presbyopic age, with patients incurring renewed expenses for visual aids on top of the already high cost of LASIK. Dr Krummenauer highlighted the fact that the patient would be glasses-free for the intervening period and that this eventuality is explained to patients who opt for LASIK in the first place.

He emphasised that no physician recommends LASIK in order to save the patient money. Patients decide to undergo LASIK for the higher comfort it promises by eliminating the need for cumbersome, and sometimes quite expensive, glasses or contacts.

As potential weak points in the study, he noted that as the patient collective was demographically limited to the two university clinics, and since LASIK costs and individual salaries vary among different regions and LASIK centres, these results might not represent the average costs in the general population.

Dr Krummenauer also admitted that only a restricted percentage of patients (56% in total) returned the follow-up questionnaire on quality of life and indirect costs. He reported that the data acquired on indirect costs was therefore rather incomplete and that the patients’ self-reported retrospective cost information may not always have been accurate.

He also pointed out that the cost-effectiveness analysis presented in the DGII poster did not take into account subjective patient satisfaction or patients who needed additional visual aids postoperatively. However, such quality of life correction had been performed, but did not have a notable qualitative impact on the overall cost effectiveness.

Co-authors of the poster were Marco Roden, Department for Medical Biometry, Epidemiology and Informatics, University of Mainz), Germany; H Burkhard Dick MD, University Eye Hospital of Mainz, Germany; Michael C Knorz, FreeVis LASIK Department, Mannheim, Germany.

Frank Krummenauer MD, DSc
Mainz University Institute for Medical Biometry, Germany
Email: krummi@imbei.uni-mainz.de